J Neurol Surg B Skull Base 2019; 80(06): 620-625
DOI: 10.1055/s-0039-1677686
Original Article
Georg Thieme Verlag KG Stuttgart · New York

CSF Rhinorrhea Following Medical Treatment for Prolactinoma: Management and Challenges

Arivazhagan Arimappamagan
1  Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Nishanth Sadashiva
1  Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Sandeep Kandregula
1  Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Dhaval Shukla
1  Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Sampath Somanna
1  Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

28 July 2018

14 November 2018

Publication Date:
21 January 2019 (online)

Abstract

Objective Cerebrospinal fluid (CSF) rhinorrhea following medical management of prolactinoma is a rare complication. We evaluated the clinical background of this condition, identify potential risk factors, and discuss the management options and challenges involved.

Methodology We retrospectively reviewed clinical details of patients who were treated for CSF leaks among patients treated for prolactinoma between 2013 and 2017.

Results Seven patients were treated for CSF rhinorrhea in the context of prolactinoma, with the age range between 24 and 56 years. Six patients had CSF leak following initiation of cabergoline, while one patient presented with CSF rhinorrhea. The time of onset of leak following medical treatment ranged from 14 days to 5 years. The mean preoperative serum prolactin level was 12,638 ng/mL (range: 1,000–26,287 ng/mL). All patients underwent repair of skull base defect. (four endoscopic, two microscopic, and one bifrontal craniotomy). The site of defect in the majority of patients was the sellar floor. Two patients who were initially managed with acetazolamide alone, eventually required surgical repair. Three patients were cured of CSF leak with a single procedure. Three patients had to undergo re-exploration and endoscopic repair after their first surgery failed. Two patients required lumboperitoneal (LP) shunt after a failed endoscopic transsphenoidal repair.

Conclusion Surgical management for medically-induced CSF rhinorrhea is necessary; however, it can pose significant issues. Endoscopic repair of the defect should be considered at the earliest. Multiple surgical procedures are often required because of skull base erosion. LP shunt can be considered if CSF leak persists following multiple surgeries.