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

机译：垂体腺瘤的自发性和医学性脑脊液漏：文献复习

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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.
机译：目的。自发性和医学性诱发的脑脊液渗漏通常与垂体腺瘤有关。这项研究的目的是进一步表征与此现象最密切相关的临床情况。方法。对文献进行了回顾，以确定所有与垂体腺瘤相关的非手术性CSF漏出病例。作者旨在确定用于治疗这些肿瘤和修复CSF漏出部位的相关危险因素和管理策略。结果。从1980年至2011年发表的29篇文章中，确认了52例因垂体腺瘤而自发或医学诱发的CSF漏出的患者。在38例患者（73％）中，开始药物治疗后出现了CSF鼻漏，而自发性CSF漏出14例（27％）表现为症状。患者的平均年龄为42.8岁（范围23-68岁）。男35例，女17例。 42例患者（81％）患有泌乳素瘤，其余患者患有以下肿瘤：垂体功能减退性腺瘤（6例），分泌生长激素的腺瘤（2例），乳腺营养细胞腺瘤（1例）和ACTH-分泌腺瘤（1例）。在56％的患者中，特别报道了瘤下肿瘤侵犯鼻旁窦。与脑脊液漏出有关的药物是多巴胺激动剂（97％）和生长抑素类似物（3％）。从就医开始到出现鼻漏的平均时间为3.3个月（范围为3天至17个月）。 4例患者接受了非手术治疗，其中1例因临时性腰椎引流成功治愈。四十六名患者（88％）接受了手术治疗，以治疗脑脊液渗漏和/或切除肿瘤。在2例患者中，由于医学上的禁忌症或患者的喜好而未进行手术。结论脑脊液鼻漏的非手术发展可能发生在垂体腺瘤的环境中，尤其是在浸润性泌乳素瘤对多巴胺激动剂治疗的良好反应后。已经报道了另外的病例为垂体腺瘤的表现症状，并且可能与由于固有的梗塞或出血，持续的侵袭和/或颅内压升高引起的肿瘤体积减小有关。推荐通过蝶窦入路进行手术修复，以彻底修复脑脊液漏并实现最大程度的肿瘤切除。

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