194 ENDOCRINE GLANDS 



Edema of the disk is not as frequent as in other forms of 

 brain tumor. Optic atrophy, by direct compression, is more 

 often met with. Ociilar paralysis is exceptional. 



Quite often these ocular disturbances are overlooked, 

 even by the patients. A certain number of pituitary 

 syndromes have only very slight ocular symptoms: 

 hemianopsia should be carefully looked for, as well as a 

 careful examination of the fundus of the eye, even in the 

 absence of any subjective symptom, when a pituitary 

 tumor is suspected. 



3. RADIOLOGICAL EXAMINATION. Oppenheim, Beclere 

 and Jeaugeas, Toupet and Infroit have insisted on the 

 special interest of radiography of the sella tursica and give 

 the technique to follow : the sella tursica must be oriented 

 to an absolutely parallel plane to the plate, and the normal 

 ray must pass perpendicular through the centre of the body 

 excavation, so that the two clinoid apophyses (anterior and 

 posterior) be superimposed ; the outline of the sella tursica 

 seen in profile, is indicated on the plate by a definite line. 



X-ray does not give definite findings when the tumor 

 develops right away towards the brain: in those cases all 

 that is noticed is an enlargement of the superior opening 

 of the sella tursica which is very difficult to appreciate. 

 More often, however, the tumor wears out and destroys 

 the bony covering; the posterior clinoid apophyses are 

 altered; the outline of the sella becomes irregular. If the 

 tumor develops forward, which is most frequently the 

 case, the sella tursica shows at the level of its pommel, an 

 excavation, very easy to see. The normal sella tursica of 

 an adult has an anterio posterior diameter of about 10 to 

 12 millimeters and has a depth of about 8 centimeters. 



Gushing recommends taking X-ray pictures of the 

 patients with the head bent slightly forward, so as to 

 appreciate the depth of the sella tursica. By means of 



