Delayed CSF Rhinorrhea after Gamma Knife Radiosurgery with or without Preceding Transsphenoidal Resection for Pituitary Pathology.

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Delayed CSF Rhinorrhea after Gamma Knife Radiosurgery with or without Preceding Transsphenoidal Resection for Pituitary Pathology.

World Neurosurg. 2017 Jan 09;:

Authors: Perry A, Graffeo CS, Copeland WR, Van Abel KM, Carlson ML, Pollock BE, Link MJ

Abstract
BACKGROUND: Skull base cerebrospinal fluid (CSF) leak after gamma knife radiosurgery (GKRS) is a very rare complication. In patients who were treated with both GKRS and transsphenoidal resection (TSR) for pituitary lesions, early CSF leak occurs at a comparable rate to the general TSR population (4%). Delayed CSF leak occurring more than a year after TSR, GKRS, or dual therapy, is exceedingly rare.
METHODS: Retrospective chart review and review of the literature RESULTS: We present two cases of delayed CSF leak following GKRS to treat pituitary adenoma. One patient developed CSF rhinorrhea 16 years following GKRS for growth hormone producing pituitary adenoma. She had previously undergone TSR surgery 7 years prior to GKRS without complication. Additionally, a 55-year-old man developed high flow CSF rhinorrhea 2 years following GKRS for a prolactinoma that failed dopamine agonist therapy. Both patients underwent a complicated clinical course following presentation, requiring multiple revisions for definitive CSF leak repair.
CONCLUSION: Delayed CSF leak is a rare but serious complication after GKRS independent of TSR status; urgent repair is the treatment of choice. Based on our experience, these leaks have the potential to be refractory, and we recommend aggressive reconstruction, preferably with a vascularized flap, and potentially supplemented by placement of a lumbar drain and acetazolamide. Current evidence is scant and provides little insight regarding an underlying mechanism, which may include bony destruction by the tumor, delayed radiation necrosis, or a secondary empty sella syndrome.

PMID: 28089836 [PubMed - as supplied by publisher]

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