Abstract
Repair of spontaneous cerebrospinal fluid (CSF) fistulas in patients with invasive
skull base prolactinomas represents a surgical challenge because of the many sites
of potential leak around the tumor and the possibility of developing additional sites
of leak as the tumor regresses on dopamine agonist therapy. Little has been published
on effective methods for treating this problem. In this case, a vascularized nasoseptal
flap was used to repair a spontaneous CSF leak in a 31-year-old male with an invasive
prolactinoma who was commenced on dopamine agonist therapy. The patient underwent
successful multilayer repair of the fistula with a nasoseptal vascularized flap and
abdominal rectus fascia. After 3 months of follow-up, he has had no CSF leak. CSF
fistulas caused by skull base prolactinomas can be repaired successfully using a vascularized
nasoseptal flap. Long-term follow-up will determine the durability of this repair
technique.
Keywords
septal mucosal flap - prolactinoma - cerebrospinal fluid leak
