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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Cerebrospinal fluid fistulae in macroprolactinomas

Meeting Abstract

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  • Sabine Hertz - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
  • Makoto Nakamura - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland; Klinik für Neurochirurgie, Kliniken Köln, Köln, Deutschland
  • Christoph Terkamp - Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland
  • Holger Leitolf - Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland
  • Stefan Stolle - Klinik für Hals-, Nasen-, Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
  • Joachim K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 118

doi: 10.3205/17dgnc681, urn:nbn:de:0183-17dgnc6817

Published: June 9, 2017

© 2017 Hertz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Cerebrospinal fluid (CSF) rhinorrhea is a rare complication after dopamine agonist treatment of macroprolactinomas. Up to 90% of these fistulae need surgical repair. However, there are controversial opinions about the necessity of radical or maximal tumor resection on this occasion. Here we present our long-term follow-up experience in three patients.

Methods: Three patients presented with cabergoline-induced CSF rhinorrhea. None of the patients had undergone prior transnasal or transcranial surgery for tumor resection. One patient with tumor expansion to the ethmoidal cells had undergone transnasal tumor biopsy two weeks prior to the onset of CSF rhinorrhea.

Results: Two out of three patients underwent transsphenoidal/transnasal surgical repair of CSF rhinorrhea by fat graft and fibrin adhesive. In one patient, CSF rhinorrhea resolved spontaneously after two weeks without recurrence (follow-up period 84 months). One out of the two patients with surgical CSF leak repair had no recurrence of CSF rhinorrhea during the follow-up period of 80 months. Due to dopamine agonist resistance, the third patient underwent tumor debulking surgery 21 months after CSF leakage repair. CSF rhinorrhea did not recur during the follow-up period.

Conclusion: In the rare case, dopamine agonist treatment of macroprolactinomas may result in CSF fistulae due to tumor shrinkage. Exceptionally, these CSF fistulae may even close spontaneously without recurrence. If persistent, closure of CSF fistulae represents an easy and efficient treatment and dopamine agonist treatment may be continued.