Non-traumatic cerebrospinal fluid rhinorrhoea.

Ommaya, Ayub K.; Chiro, Giovanni Di; Baldwin, Maitland; Pennybacker, Joe

doi:10.1136/jnnp.31.3.214

Cited by 326 publications

(179 citation statements)

References 18 publications

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“…6 In cases of spontaneous (non iatrogenic) rhinorrhea, the cause of tumor shrinkage is not well understood, but it is likely related to intratumoral infarction and/or hemorrhage with subsequent reduction in tumor volume, 23 ongoing invasion through the arachnoid or bony skull base, and/or increases in intracranial pressure resulting in a CSF fistula. 32 The development of meningitis should be anticipated and addressed in advance in cases of nonsurgical CSF leak.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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Object Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon. Methods A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site. Results Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference. Conclusions Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.

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Section: Discussionmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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“…Ommaya's theory of focal atrophy 8 states that the contents of the cribiform plate or sella turcica are diminished in bulk due to ischaemia. The empty space becomes a pouch filled with CSF thus enabling the normal CSF pressure pulse to exert a focal and erosive effect.…”

Section: Introductionmentioning

confidence: 99%

Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

Sayed¹,

Dunn²,

Alaani³

et al. 2013

Med. Today

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“…(3,8) Midline transsphenoidal fistulas are usually situated in the anteroinferior wall of the sella, which is both a zone of least resistance and an area most affected by the (c) Axial CT cisternography image shows a partially empty sella (arrow). At surgery, a well-defined, smooth defect was seen in the left cribriform plate and an arachnoid pouch was seen to herniate through the defect.…”

Section: High -Resolution Ctmentioning

confidence: 99%

Spontaneous cerebrospinal fluid rhinorrhoea: computed tomography and magnetic resonance imaging findings

Choong

Venkatesh²,

Phadke

2013

smedj

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Spontaneous cerebrospinal fluid rhinorrhoea is a rare clinical entity. The accurate localisation of the leakage site is essential for surgical planning. Imaging techniques such as high-resolution computed tomography (CT), CT cisternography and magnetic resonance cisternography in variable combinations are performed for this purpose. This pictorial essay aims to present the spectrum of imaging findings in cases of spontaneous cerebrospinal fluid rhinorrhoea, which may be useful for radiologists in the determination of the site of cerebrospinal fluid leakage.

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Non-traumatic cerebrospinal fluid rhinorrhoea.

Cited by 326 publications

References 18 publications

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

Spontaneous cerebrospinal fluid rhinorrhoea: computed tomography and magnetic resonance imaging findings

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