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August 1990

Can Empty Sella Syndrome Be Mistaken for a Progressive Form of Nonarteritic Ischemic Optic Neuropathy?

Author Affiliations

Edinburgh, Scotland

Arch Ophthalmol. 1990;108(8):1066-1067. doi:10.1001/archopht.1990.01070100022010

To the Editor.  —We read with great interest the article by Sergott et al1 in the December 1989 issue of the Archives.We find it difficult to determine the exact nature of their decompressive procedure. The authors persistently mention multiple linear incisions of the meningeal sheath and lysis dissection of arachnoidal adhesions within the subdural space, and they refer to the presence of cerebrospinal fluid and blood elsewhere within the subdural space. The subdural space is only a potential space and is normally empty, and frequent adhesions between dura and arachnoid are found in normal individuals.2,3 Cerebrospinal fluid is present and circulates in the subarachnoid space and it has been well established that an increase of pressure in this area is associated with papilledema, which can be relieved by decompression of the optic nerve sheath, but the arachnoid must be opened to achieve this goal. In the specimens