Postoperative Care

Monitoring and Follow-up

Intensive neurological monitoring should be performed for at least 24 hours postoperatively, maintaining normotensive and euvolemic conditions, as recommended by the American Heart Association 1
Follow-up with magnetic resonance imaging (MRI) is recommended to be repeated at least every 6 months until complete resolution of cystic lesions, according to the Infectious Diseases Society of America 2
MRI with high-resolution pituitary protocols is the gold standard for diagnosis of pituitary gland abnormalities and can show a flattened pituitary gland against the sellar floor, CSF-filled sella turcica, and confirm absence or ectopia of the posterior pituitary gland, as recommended by the American College of Radiology 3

MRI of the head and orbits is the gold standard for diagnosing IIH, detecting characteristic findings including posterior globe flattening, optic nerve sheath distention, and transverse sinus stenosis, according to the American College of Radiology 4, 5
Specific MRI findings have the following sensitivities and specificities for diagnosing IIH:
MR Venography (MRV) is essential to evaluate for narrowing of distal transverse sinuses, which is supportive of IIH diagnosis, according to the American College of Radiology 4
CT Venography (CTV) can be used as an alternative to MRV if MRI is contraindicated, although it is less preferred, as reported by the American College of Radiology 4
CT scans are less sensitive than MRI, but may show sellar enlargement, and can detect solid lesions, but can miss cystic tumors, as stated by the American College of Radiology 3
The American College of Radiology does not recommend CT scans as first-line imaging for pituitary gland abnormalities 3

Ophthalmologic examination is mandatory to assess for papilledema, according to the Journal of Neurology, Neurosurgery and Psychiatry 5
Lumbar puncture is necessary to measure opening pressure, with a diagnostic criterion of >250 mm CSF in adults or >280 mm CSF in children, as reported by the American College of Radiology and the Journal of Neurology, Neurosurgery and Psychiatry 4, 5
CSF composition should be normal, according to the Journal of Neurology, Neurosurgery and Psychiatry 5
Visual field testing, blood pressure measurement, and assessment for symptoms of hormone deficiencies are crucial in patients with empty sella syndrome, as these symptoms can be indicative of underlying hormonal imbalances 3

Comprehensive hormonal evaluation is necessary for patients with partial empty sella, as up to 40% of patients may have at least one hormone deficiency, according to the American College of Radiology 3
Hormone replacement therapy should be initiated based on specific deficiencies, such as levothyroxine for hypothyroidism, cortisone acetate for hypoadrenalism, growth hormone replacement if deficient, and sex hormone replacement for hypogonadism, as recommended by the American College of Endocrinology 3, 6
Patients with adrenal insufficiency should obtain and carry a medical alert bracelet, as recommended by the American College of Endocrinology 6
Physiologic doses of steroids, such as hydrocortisone 15-25 mg daily in divided doses, should be administered to patients with adrenal insufficiency, according to the American College of Endocrinology 6

Most patients with partial empty sella have a good prognosis and remain asymptomatic, according to the American College of Radiology 3
In atypical presentations, secondary causes of increased intracranial pressure should be thoroughly investigated, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry 5
Up to 30% of patients with empty sella may demonstrate some degree of hypopituitarism upon testing, according to the American College of Radiology 3
Comprehensive assessment and regular endocrine evaluation are necessary to avoid overlooking up to 30% of patients with hypopituitarism requiring treatment, and to distinguish between primary and secondary empty sella syndrome, which requires specific attention to the underlying cause, as recommended by the American College of Radiology 3