The imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid rhinorrhea in patients with pituitary tumor

Abstract

Objective To investigate the imaging characteristics and nasal endoscopic repair surgery for delayed postoperative cerebrospinal fluid (CSF) rhinorrhea in patients with pituitary tumor.  Methods From June 2009 to November 2014 there were 23 cases with delayed CSF rhinorrhea in our hospital, which occurred one year to 5 years after the operation for pituitary tumor. Pituitary hormone assay, head MRI, cisternal CT and nasal endoscopic examination were performed in all patients. After definite diagnosis the patients underwent nasal endoscopic repair surgery of CSF rhinorrhea. During the operation, large leakage orifices were packed with muscle, and then patched with xenogenic acellular dermal matrix, while the small ones were directly patched with xenogenic acellular dermal matrix after tumor resection, and the sphenoid sinus was packed with gelatin sponge and iodoform gauze.  Results Patients were hospitalized for 3 to 5 weeks. Among them, 20 patients were successfully recured after one nasal endoscopic repair surgery, 2 underwent the second surgery, and one underwent the third surgery. Patients were followed up for 3 months to 5 years with no CSF rhinorrhea reoccurred.  Conclusions Delayed postoperative CSF rhinorrhea in patients with pituitary tumor were likely due to residual tumor growth and postoperative radiotherapy. Pituitary tumor often occur in sella, thus nasal endoscopic resection and repair surgery is feasible in treatment. The surgery is safe and the success rate is high. DOI: 10.3969/j.issn.1672-6731.2017.09.012