Untreated Non-Functioning Pituitary Adenoma Causing Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

2020 ◽  
Vol 103 (9) ◽  
pp. 960-963
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Case Reports ◽  
Medical Attention ◽  
Nasal Discharge ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Presenting Symptoms ◽  
Csf Leakage

Cerebrospinal fluid (CSF) leakage is common with traumatic brain injury or after transsphenoidal surgery (TSS). In contrast, spontaneous rhinorrhea caused by pituitary adenoma (PA) without prior treatment is rather unusual. Moreover, cases of non-functioning PA (NFPA) who seek medical attention without visual or hormonal symptoms but with watery nasal discharge, mistaken for rhinitis, and misled to delayed diagnosis, are extremely rare. The authors presented a case of spontaneous CSF rhinorrhea, confirmed by clinical, laboratory, and radiographic studies, caused by NFPA. Endoscopic TSS came across a typical PA, and subsequently, the sellar defect was successfully repaired. Pathological diagnosis of NFPA was established. The patient had an uncomplicated postoperative course and complete resolution of her presenting symptoms. A short review of prior case reports is also provided. Keywords: Spontaneous cerebrospinal fluid rhinorrhea, Pituitary adenoma, Non-functioning, Endoscopic transsphenoidal surgery

Prevention of Cerebrospinal Fluid Rhinorrhea After Transsphenoidal Surgery by Collagen Fleece Coated With Fibrin Sealant Without Autologous Tissue Graft or Postoperative Lumbar Drainage

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons130-ons137 ◽  
Author(s):  
Jin Mo Cho ◽  
Jung Yong Ahn ◽  
Jong Hee Chang ◽  
Sun Ho Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Fibrin Sealant ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Autologous Tissue ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Tissue Graft ◽  
Csf Leakage ◽  
Sellar Floor

Abstract BACKGROUND: Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery. OBJECTIVE: To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD. METHODS: We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction. RESULTS: The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection. CONCLUSION: Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

Clipping Technique for the Repair of the Intraoperative Cerebrospinal Fluid Leakage during Transsphenoidal Pituitary Tumor Surgery

2019 ◽  
Vol 17 (4) ◽  
pp. 382-388
Author(s):  
Eui Hyun Kim ◽  
Ju Hyung Moon ◽  
Sun Ho Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Anterior Pituitary ◽  
Pituitary Function ◽  
Cerebrospinal Fluid Leakage ◽  
Arachnoid Membrane ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Anterior Pituitary Function ◽  
Clipping Technique

Abstract BACKGROUND During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.

scholarly journals Spontaneous cerebrospinal fluid rhinorrhea in a patient with Pallister–Hall syndrome

2019 ◽  
pp. 305-309
Author(s):  
Milicevic Mihajlo ◽  
Aleksic Vuk ◽  
Ilic Rosanda ◽  
Scepanovic Vuk ◽  
Stanimirovic Aleksandar ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Late Onset ◽  
Incidental Finding ◽  
Rare Condition ◽  
The Body ◽  
Hypothalamic Hamartoma ◽  
Nasal Discharge ◽  
Autosomal Dominant Disorder ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Pallister-Hall syndrome (PHS) is extremely rare autosomal dominant disorder with typical clinical features such as presence of polydactyly, hypothalamic hamartoma, bifid epiglottis, anal, renal, genitourinary and pulmonary abnormalities, mainly located in the midline of the body. Spontaneous cerebrospinal fluid (CSF) rhinorrhea is also a rare condition, and it is used to describe nasal discharge of CSF unrelated to previous trauma, localized tumour, surgery, or previous radiation therapy. The exact cause is not yet fully understood. We report a case of adult female patient previously diagnosed with PHS and late onset of spontaneous nasal liquorrhea, due to defect in the anterior skull base. Although it can be incidental finding, we believe that described defect in the body midline can be another presentation of congenital craniofacial abnormality which are common in PHS.

scholarly journals Risk Factors For Postoperative Cerebrospinal Fluid Leakage After Transsphenoidal Surgery For Pituitary Adenoma: A Meta-Analysis And Systematic Review

2021 ◽  
Author(s):  
Zhihuan Zhou ◽  
Feifei Zuo ◽  
Xiaoqun Chen ◽  
Qinqin Zhao ◽  
Mengna Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Cohort Studies ◽  
Transsphenoidal Surgery ◽  
Case Control ◽  
Cochrane Library ◽  
Cerebrospinal Fluid Leakage ◽  
Csf Leakage

Abstract Objective: Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).Methods: PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.Results: A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).Conclusions: This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

scholarly journals Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

2001 ◽  
Vol 59 (2A) ◽  
pp. 263-265 ◽  
Author(s):  
Ricardo Alexandre Hanel ◽  
Daniel Monte Serrat Prevedello ◽  
Alceu Correa ◽  
Affonso Antoniuk ◽  
João Cândido Araújo
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Sella Turcica ◽  
Rare Condition ◽  
Normal Serum ◽  
Cerebrospinal Fluid Fistula ◽  
Csf Rhinorrhea ◽  
Csf Leakage ◽  
Bony Erosion

We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.

Lymphangioma of the skull base bones leading to cerebrospinal fluid rhinorrhea

2008 ◽  
Vol 2 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Eiji Ito ◽  
Kiyoshi Saito ◽  
Tetsuya Nagatani ◽  
Masaaki Teranishi ◽  
Yuzuru Kamei ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Skull Base ◽  
Histopathological Examination ◽  
Bone Destruction ◽  
Lytic Lesion ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
The Right

Lymphangioma localized to the bones of the skull base is rare. The authors report herein the case of a 5-year-old boy who presented with lymphangioma of the bone, localized to the skull base and leading to cerebrospinal fluid (CSF) rhinorrhea with meningitis. Neuroimaging demonstrated lytic destruction with a cyst in the right middle skull base. The patient was successfully treated with resection of the tumor and prevention of CSF leakage. Histopathological examination revealed a lymphangioma. An enlarging lymphangioma can lead to bone destruction. A differential diagnosis of a lytic lesion for a cyst at the skull base is important for proper case management.

scholarly journals Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhihuan Zhou ◽  
Feifei Zuo ◽  
Xiaoqun Chen ◽  
Qinqin Zhao ◽  
Mengna Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Cohort Studies ◽  
Transsphenoidal Surgery ◽  
Case Control ◽  
Cochrane Library ◽  
Cerebrospinal Fluid Leakage ◽  
Csf Leakage

Abstract Objective Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA). Methods PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors. Results A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69). Conclusions This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

scholarly journals Cabergoline-Induced Pneumocephalus Following Treatment for Giant Invasive Macroprolactinoma Presenting With Spontaneous Cerebrospinal Fluid Rhinorrhea

2018 ◽  
Vol 11 ◽  
pp. 117955141875864 ◽  
Author(s):  
Souha S Elabd ◽  
Maswood M Ahmad ◽  
Sameer Q Qetab ◽  
Mussa Hussain Almalki
Keyword(s):  
Cerebrospinal Fluid ◽  
Medical Treatment ◽  
Case Reports ◽  
Rare Complication ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Surgical Interventions ◽  
Tension Pneumocephalus ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Uncommon Presentation

Cerebrospinal fluid (CSF) rhinorrhea is rarely reported as the first presenting feature of giant invasive macroprolactinomas. Cerebrospinal fluid rhinorrhea is usually reported as a complication of trauma, neurosurgical, and skull-based procedures (such as pituitary surgery or radiations), and less frequently after medical treatment with dopamine agonists (DAs) for macroprolactinomas. This phenomenon results from fistula creation that communicates between the subarachnoid space and the nasal cavity. Meanwhile, pneumocephalus is another well-recognized complication after transsphenoidal surgery for pituitary macroadenomas. This entity may present with nausea, vomiting, headache, dizziness, and more seriously with seizures and/or a decreased level of consciousness if tension pneumocephalus develops. Case reports about the occurrence of spontaneous pneumocephalus after medical treatment with DAs without prior surgical interventions are scarce in the literature. Our index case is a young man who was recently diagnosed with a giant invasive prolactin-secreting pituitary macroadenoma with skull base destruction. A few months before this diagnosis, he presented with spontaneous CSF rhinorrhea with no history of previous medical or surgical treatment. In this case report, we report an uncommon presentation for giant invasive macroprolactinoma with a CSF leak treated with cabergoline that was subsequently complicated by meningitis and pneumocephalus. This is a very rare complication of cabergoline therapy, which occurred approximately 1 month after treatment initiation.

Evaluation of Endoscopic Transnasal versus Non-endoscopic Routes as Surgical Treatment of Cerebrospinal Fluid Rhinorrhea

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ashraf Mohamed Farrag ◽  
Talaat Ali Hassan El Samnni ◽  
Tamer Abdul Wahab El Sabri Abou El Ezz ◽  
Mohamed Naguib Mohamed El Sayed
Keyword(s):  
Cerebrospinal Fluid ◽  
Meta Analysis ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage ◽  
Fluid Leak ◽  
The Brain ◽  
Better Than

Abstract Introduction Cerebrospinal fluid (CSF) leak happens when there is an abnormal connection between the brain cavity inside and environment outside. It is important to establish a good barrier between the brain tissue and the nose to prevent cerebrospinal fluid leak and protect the brain from exposure to infection. which can be done either by endoscopic or non-endoscopic surgical repair. Patients and methods The aim of this work is to evaluate the effectiveness of endoscopic and non-endoscopic repair of CSF leakage in patients suffering from CSF rhinorrhea. The search retrieved 1693 unique records. We then retained 89 potentially eligible records for full-texts screening. Finally, 11 studies (Total No. of patients = 355) were included in the present systematic review and meta-analysis. Results CSF rhinorrhea resolved in endoscopic surgery group giving a success rate of 88.8%to 100%. recurrence rate is 2% to 12.2% and postoperative complications occurred in 5% to 16.7%. Conclusion The endoscopic approach is highly effective, better than non-endoscopic route and is associated with low morbidity for the management of CSF rhinorrhea .

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