X-ray (radiography) of the Turkish saddle

Diseases localized in the region of the skull and brain, of course, are most informative and safe for the patient to examine through magnetic resonance or computed tomography. However, not every medical institution has the appropriate equipment, and in some situations associated with damage to the skull or brain, there is no time to transfer the patient to a clinic where the necessary technical devices are available. The simplest, most common and affordable way to diagnose the destructive processes of bone or soft tissues of the head is still radiography. This procedure is effective, among other things, for examining such a part of the skull as the Turkish saddle.

What is the Turkish saddle, what organs surround it

The features of the structure of the brain and the cranium are anatomically interconnected and complement each other, since the skull is, in fact, a kind of protective box for the “central processing unit” of the human body. One of these anatomical features of the skull is the Turkish saddle – a bone formation that looks like a kind of depression in the sphenoid bone of the skull. This area received such a specific name for its visual similarity with a saddle.

The height of the saddle, measured from the deepest point of the bottom to the point of intersection with its diaphragm, is about 9 millimeters. Normally, a value of 7 to 12 millimeters is allowed. The anterior-posterior or sagittal size of the Turkish saddle (its length) is from 9 to 15 millimeters. The ratio of these values ​​to each other is called the saddle index, and during a person’s life it changes – in childhood it tends to one, in an older age it decreases.

In the center of this recess is a fossa where the pituitary gland is located – a gland that produces hormones involved in the processes of metabolism, growth and development of the human body. Actually, the Turkish saddle is a partition that separates the lower parts of the brain tissue. The size of the fossa corresponds to the size of the pituitary gland.

Behind the saddle is limited by bone tissue – the “back”, on top of it is the dura mater – the diaphragm of the Turkish saddle. In the center of the diaphragm there is an opening for the pituitary stalk. The leg is a kind of channel connecting the pituitary gland with another part of the brain – the hypothalamus. In front of the tubercle of the saddle there is a longitudinal precrossing strip, behind which is the optic chiasm.

The diaphragm performs the function of protecting the pituitary gland from subsidence of the meninges. The pituitary gland is one of the most important centers of the endocrine system of the human body. The Turkish saddle is its protective “shelter”, which protects this part of the brain from mechanical compression.

Why is an x-ray of the Turkish saddle prescribed, what pathologies it can reveal

Any pathological processes in the area of ​​the Turkish saddle have an extremely negative impact on the general condition of a person, since they become the direct cause of disorders in the pituitary gland.

X-ray of the Turkish saddle is an informative and painless diagnostic method, which doctors consider one of the most informative. X-ray images visualize bone tissue especially well, so they can be used to determine the shape, size and contours of the Turkish saddle, as an anatomical structure of the skull, compare them with normal values, and identify deviations from the norm. Radiography is also prescribed in order to establish the presence of indications for surgical intervention.

The referral for the procedure is issued by a therapist, endocrinologist, neuropathologist, oncologist, ophthalmologist, neurosurgeon or gynecologist.

Indications for examination of the Turkish saddle

Radiography of the skull, including the Turkish saddle, can only be carried out at the discretion of the attending physician, since this method is associated with a certain level of radiation exposure. The doctor directs the patient to such an examination, if there are objective indications for this. All of them are divided into three general groups, which are:

• visual disturbances;
• endocrine dysfunction;
• a variety of neurological pathologies.

The most common reasons for the appointment of an x-ray of the Turkish saddle:

• suspicion of “empty Turkish saddle” syndrome;
• cephalgia of unknown origin;
• acromegaly (an endocrine disease manifested by abnormal production of growth hormone by the pituitary gland);
• inflammation of the brain or its membranes;
• diabetes insipidus (a disease associated with a violation of carbohydrate metabolism in the body, which appears as a result of pathologies of the pituitary gland or hypothalamus);
• gigantism;
• increased intracranial pressure;
• traumatic brain injury, if there is reason to suspect injury to the pituitary gland, as well as trauma to the cranial vault;
• visual disturbances: pain in the eye sockets, double vision in the eyes, increased lacrimation, decreased visual acuity;
• problems in the work of the adrenal glands, thyroid gland.

What is the “empty saddle” syndrome, why is it dangerous for humans

This disease was first discovered by scientists in 1951. Since then, despite ongoing research, they have not been able to discover the causes of this anomaly. However, empirically, they managed to prove that the development of this pathology is facilitated by factors such as:

• radiation exposure or surgical interventions on the cranium;
• cardiovascular diseases;
• hormonal disorders that occur during pregnancy, puberty and menopause;
• neurological disorders.

In fact, the “empty sella” syndrome refers to the incorrect location of the pituitary gland in the fossa of the saddle. Normally, the pituitary gland fills the fossa completely, and in the presence of the syndrome, the soft membranes of the brain, descending, seem to press the pituitary gland to the bottom of the Turkish saddle, which causes its thinning.

The consequences of the appearance of pathology are reproductive dysfunction, decreased immunity, sexual dysfunction, decreased visual acuity (in some cases, even blindness), the appearance of chronic headaches, as well as an increased risk of developing a microstroke.

In what cases does a gynecologist refer a procedure?

The entire human body is a complex system. In it, all parts are interconnected, even if at first glance the connection is not obvious. Therefore, when a gynecologist sends for an x-ray examination of the Turkish saddle – a bone depression in the structure of the skull – do not be surprised.

The condition of the Turkish saddle directly affects the health of the pituitary gland. The pituitary gland, in turn, is part of the human endocrine system, and in the female body it produces various hormones that are closely related to the sexual and reproductive health of women, including:

• thyrotropic;
• follicle-stimulating;
• luteotropic (prolactin);
• luteinizing;
• gonadotropic;
• adrenocorticotropic;
• oxytocin;
• melanostimulating hormone.

Each of these hormones plays a role in the functioning of the female genital organs. Some are involved in the process of ovulation, without others, follicles cannot form in the body of a woman, and others are formed during pregnancy, and contribute to its normal course.

A gynecologist can send a patient for an X-ray examination of the Turkish saddle if:

• menstrual irregularities;
• infertility;
• increase in the level of prolactin in the blood.

Violations of the functioning of the pituitary gland in women are also manifested by general malaise, increased process of wrinkle formation, deterioration of skin elasticity, not associated with age-related changes. In such patients, hair begins to fall out intensively, they become dull and brittle, appetite worsens and frequent constipation appears.

In addition to an x-ray of the Turkish saddle, a gynecologist may recommend a visit to an endocrinologist, as well as testing for hormones of the pituitary gland and other endocrine glands.

Are there any contraindications for the procedure, and how to prepare for it

The main prohibition that doctors adhere to when choosing this method of examination for a patient is the incompatibility of radiography and pregnancy. Indeed, pregnant women, especially in the early stages, when the fetus is laying all future organs and systems, it is not recommended to irradiate with X-rays. If possible, alternative diagnostic tests should be performed, in particular magnetic resonance imaging.

As for the implementation of radiography for children, in each case, the doctor measures the risk of exposure to the objective need for diagnosis. If it is impossible to conduct an examination in another way, in exceptional cases, X-rays can be done even for children under one year old.

The procedure is not associated with the introduction of a contrast agent, therefore, allergic reactions cannot occur due to it. The only potential danger from x-rays is radiation exposure to the body. Therefore, x-rays are not recommended more than once every 6 months.

No special preparation for x-rays is required. Women before the procedure must be sure to inform about the presence of pregnancy.

How is an x-ray of the Turkish saddle performed?

The procedure is carried out in radiographic rooms equipped with appropriate equipment.

Immediately before the examination, the patient must remove all jewelry and accessories from the neck and head: glasses, headbands, hairpins, earrings, chains, piercings.

The subject is placed between the recording plate and the x-ray tube. Pictures can be taken in a sitting or lying position. First, the patient is sideways to the apparatus and the plate – such an image has a lateral projection. Next, the image is fixed in the frontal projection. Usually, doctors need an X-ray of the Turkish saddle in two projections, however, in some cases, they need to take a few more pictures from other projections.

The procedure itself usually lasts no more than five minutes, and is completely painless.

Features of interpretation of survey results

The resulting images – lateral and frontal craniogram – are analyzed by a radiologist.

The main categories used in the process of deciphering images:

• sagittal size;
• vertical size;
• the shape of the Turkish saddle;
• location, shape and dimensions of the saddle back.

For an objective analysis of the results, the images must be recorded taking into account the requirements of proper stacking and centering. The correctness is determined by the complete coincidence of the projections of the anterior sphenoid processes, internal and external auditory openings.

Normally, the plane of the wedge-shaped eminence and the pituitary fossa in the sella turcica are visualized on the images as single lines with a clear, intense contour.

D. G. Rokhlin proposed his own method for estimating the size of the pituitary fossa of the sella turcica from radiographic images. For this, the image of the skull in the frontal projection is used. The Rokhlin technique is considered one of the most objective and accurate schemes.

The sagittal dimension is defined as the maximum distance between the posterior and anterior walls of the fossa. In this case, the line that connects the extreme points of the fossa, which are the most distant from each other, has a direction parallel to the plane of the wedge-shaped eminence. The normal sagittal size in an adult is no more than 14 millimeters.

The process of refining the vertical size of the fossa is impossible without drawing a projection line of the sella turcica diaphragm in the image. Normally, it connects the middle and posterior sphenoid processes. If the middle ones are not visualized on the picture, the projection is determined by connecting the tubercle of the saddle and the posterior processes. In some cases, for example, in children, the posterior sphenoid processes may not be displayed on the radiograph, so the projection is carried out by connecting the tubercle of the saddle and the top of the back of the saddle with a line. In addition to this line, an auxiliary tangent line is established to the lowest point of the edge of the pituitary fossa. It is located parallel to the surface of the wedge-shaped eminence. A perpendicular is drawn from the indicated tangent to the midpoint of the bottom of the pituitary fossa. The vertical size of the pit is measured from the tangent to the intersection of the perpendicular with the diaphragm projection. Its normal length is up to 12 millimeters.

The shape of the Turkish saddle is a very individual category. In order to be able to generalize and evaluate it, scientists proposed to calculate the saddle index – the ratio of vertical and sagittal dimensions. A flat fossa is one in which the sagittal dimension is greater than the vertical dimension. If both sizes are equal, the hole is considered round. If the larger size is vertical, then the hole is deep.

It is noteworthy that both sizes of the fossa tend to change from childhood to the end of the body’s maturation, and the sagittal size can increase even after the entire body stops growing.

In children under 2-3 years of age, a flat form of the pituitary fossa is usually found. By the age of 4-5 years, the vertical size becomes equal to the sagittal one, that is, the fossa acquires a round shape, and then it becomes larger than the sagittal size. The round or deep shape of the fossa, starting from this age, persists up to 15 years in boys and up to 8 years in girls, after which the sagittal size begins to increase rapidly, which is why in adults in the picture you can most often find a flat shape of the pituitary fossa of the saddle.

The back of the saddle is displayed as a flat or concave sharp line in the pictures. Basically, it has a vertical arrangement, however, a slight tilt forward or backward is allowed. Its thickness is from 1 to 10 millimeters.

To study the features of the shape and location of the back of the Turkish saddle, the doctor needs to have sighting radiographs in the nasofrontal and posterior occipital projections. In such pictures, the back is defined as a rectangle, which expands slightly upward. The transverse size of the back in an adult can reach 15 millimeters.

In addition to these values, the radiologist also pays attention to the structure of the sphenoid processes. The front ones are usually equal in size, while the back ones can be located at different angles or vertically, and have different sizes. The technically correct images also show the middle sphenoid processes.

Suspicion of a pituitary tumor

The presence of tumor formations in the picture can be determined by several signs. The tumor is determined by the thinning of the walls of the fossa. In addition, in the images of a patient with a pituitary tumor, atrophic processes of the bone walls of the saddle and thinning of the sphenoid processes are noted. The contours of the saddle at the same time have an uneven character, the symptom of “double contours” is also noted.

The radiography method of the Turkish saddle allows only to suspect the presence of a tumor, or to detect a neoplasm if it is already large enough. If there are possible signs of a tumor lesion in the picture, the attending physician directs the patient for additional examinations – magnetic resonance or computed tomography.

The Turkish saddle is a special structure of the skull, a bony depression, which, despite its small size, performs an extremely important function in the body. The pituitary gland is located in the saddle fossa, which is responsible for the production of many different hormones. The normal anatomical structure of the Turkish saddle guarantees the protection of the pituitary gland from the mechanical pressure of the tissues surrounding the gland.

In cases where the Turkish saddle has deviations from the norm in size, location or shape, as well as due to injuries and congenital pathologies, the functioning of the pituitary gland occurs. The consequences of such violations are manifested in the form of growth anomalies, reduced fertility, visual impairment, and other ailments. Timely and accurate diagnosis of the state of the sella turcica using radiography makes it possible to determine the causes of certain pathologies and diseases of an endocrine or neurological nature, as well as to develop an adequate treatment strategy.