Pituitary adenomas associated with cerebrospinal fluid rhinorrhea and its transsphenoidal surgical treatment

Objective To introduce the clinical features and surgical management of pituitary adenomas associated with cerebrospinal fluid rhinorrhea. Methods To describe the cases of five patients with pituitary adenomas who presented with CSF rhinorrhea,all of whom were treated by transsphenoidal surgical procedure between 1991 and 1997 in our department,and with reviewing the literature to discuss the surgical treatment and mechanisms involved in this rare condition.Results ln five patients,there were four giant prolactinomas and one nonfunctioning pituitary adenoma coexisting with a partially empty sella,and two patients presented CSF rhinorrhea as initial and only presenting symptom.The length of postoperative follow up ranged from 6 months to 6 years,total tumor removal were achieved in three cases,subtotal removal were effected in two cases,the CSF rhinorrhea disappeared in all of these patients. Conclusion CSF rhinorrhea can occur spontaneously in patients with giant pituitary adenomas,or less frequently,in patients with pituitary adenomas coexisting with partially empty sellas,and treatment of pituitary adenomas with radiation or bromocriptine may precipitate rhinorrhea.Surgical treatment using transsphenoidal approach is the most suitable for these patients;Packing sphenoid sinus hermetically after tumor removal is an effective method to obliterate the cerebrospinal fluid rhinorrhea;Resting in bed with supine position without pillows and draining CSF continuously via a lumbar subarachnoid catheter after operation are helpful in healing the repairs.