title: Delayed cerebrospinal fluid rhinorrhea after gamma knife surgery in a patient with a growth hormone-secreting adenoma.
abstract: We report a patient who developed delayed cerebrospinal fluid (CSF) rhinorrhea 11 years after gamma knife radiosurgery for a growth hormone (GH)-secreting adenoma. The treatment dose was 18 Gy for the tumor margin (50% isodose). One year later, an MRI of the head revealed that the tumor size had decreased. Eleven years later, the patient developed CSF rhinorrhea from the left nostril. Subsequent MRI examination revealed complete remission of the tumor in the sella turcica and the empty sella. The patient was admitted for direct endoscopic surgical repair of the skull base. We suggest that the cause of the CSF rhinorrhea is secondary empty sella. The other potential causes may be the original invasiveness of the tumor or delayed radiation damage to the mucous membranes of the skull. Long-term follow-up is required to monitor recurrence of CSF rhinorrhea.
authors.affiliation: Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Avenue, Xicheng District, Beijing 100053, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Hongmei
authors.forename: Wang
authors.initials: W
authors.lastname: Zhe
authors.forename: Wang
authors.initials: W
authors.lastname: Jing
authors.forename: Wang
authors.initials: W
authors.lastname: Daokui
authors.forename: Cao
authors.initials: C
authors.lastname: Peicheng
authors.forename: Li
authors.initials: L
authors.lastname: Yongjie
mesh_terms: D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000601:surgery*; D005260:Female; D013006:Growth Hormone / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*
chemical_list: D013006:Growth Hormone