Pathogenesis of non-traumatic cerebrospinal fluid rhinorrhea.
15 consecutive patients with non-traumatic cerebrospinal fluid rhinorrhea were studied. 13 operations were performed on 10 patients. In 8 transcranial operations, an assumed defect in the anterior fossa was plugged with muscle, but only 3 operations were successful. In 4 operations, either transcranial or transsphenoidal, the sella was packed with muscle and rhinorrhea ceased immediately. Based on radiological and operative findings, 3 groups of patients appeared (1) 9 patients had pathology related to the pituitary gland or the sella turcica: enlarged sella, empty sella, pituitary tumour, intrasellar cyst or erosion of the sellar osseous border. (2) 2 patients had rhinorrhea from extrasellar origin. (3) In 4 patients no abnormality could be found. Prior to the rhinorrhea, 6 patients (5 from group 1 and 1 from group 3) had experienced episodes of neurological symptoms, compatible with a pituitary apoplexy. It is suggested that non-traumatic cerebrospinal fluid rhinorrhea in most cases is the result of a spontaneous necrosis in a pituitary adenoma, which has caused sellar bony erosion.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004652:Empty Sella Syndrome / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011011:Pneumoencephalography; D011559:Pseudotumor Cerebri / Q000150:complications; D012658:Sella Turcica / Q000601:surgery; D014057:Tomography, X-Ray Computed