title: Spontaneous cerebrospinal fluid rhinorrhea as the presenting symptom of sellar pathologies: three demonstrative cases.
abstract: Spontaneous rhinorrhea due to sellar pathologies is a rare and insidious disease that may represent a diagnostic challenge. Since the precipitating cause is not apparent in most patients, delayed diagnosis and/or improper treatments are not uncommon and may be detrimental for the patients. The precise mechanisms of such rhinorrhea are still incompletely understood. Proposed etiological factors include constant cerebrospinal fluid pulsations against the anterior skull base transmitted by primitive or acquired arachnoid invaginations in combination with either elevated ICP or congenital/pathologic erosions of sellar and parasellar bone structures. Advances in the diagnosis and surgical techniques have recently modified the decision-making approach to this pathology. The present paper reports three unusual cases of sellar pathologies revealed by rhinorrhea as the first symptom discussing controversial issues on pathogenesis, complications and current management of this kind of fistula.
authors.affiliation: Division of Neurosurgery, "Regina Elena", National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. telera@ifo.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Telera
authors.forename: Aristide
authors.initials: A
authors.lastname: Conte
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cristalli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Occhipinti
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pompili
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology; D012658:Sella Turcica / Q000473:pathology*; D014057:Tomography, X-Ray Computed