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.
Keywords
CSF rhinorrhea - prolactinoma - medical management - cabergoline - surgical management
- failure
