Honegger J B, Psaras T, Petrick M, Beuschlein F, Reincke M
Klinik für Neurochirurgie, Universitätsklinik Tübingen, Germany.
Zentralbl Neurochir. 2006 Aug;67(3):149-54. doi: 10.1055/s-2006-942145.
Medical therapy is usually indicated as first-line treatment for prolactinomas. Surgery is generally reserved as second-line therapy if prolactinomas are non-responsive to dopamine agonists (DA) or DA therapy is not tolerated. Herein, we draw attention to the rare occurrence of spontaneous CSF rhinorrhea in prolactinomas requiring primary surgical therapy. Only 8 cases of confirmed prolactinomas with spontaneous rhinorrhea have been reported in the literature so far.
Two out of 267 surgical cases with pituitary adenomas presented with spontaneous rhinorrhea. Both patients harbored invasive prolactinomas. In both cases, the defect was exposed using a transsphenoidal procedure and was sealed with fascia lata.
Urgent surgical repair of the leak prevented meningitis. In one case, a second operation was required due to recurrent rhinorrhea under postoperative dopamine-agonist therapy of the residual tumor. The clinical course was otherwise uncomplicated.
Certain clinical settings still require primary surgical therapy of prolactinomas. Spontaneous rhinorrhea caused by invasive macroprolactinomas represents a mandatory indication for initial surgery. Early detection and surgical repair of a CSF leak is crucial for a favorable clinical outcome.
药物治疗通常被指定为泌乳素瘤的一线治疗方法。如果泌乳素瘤对多巴胺激动剂（DA）无反应或无法耐受DA治疗，手术通常作为二线治疗方法。在此，我们提请注意在需要进行初次手术治疗的泌乳素瘤中罕见的自发性脑脊液鼻漏情况。迄今为止，文献中仅报道了8例确诊的伴有自发性鼻漏的泌乳素瘤病例。
267例垂体腺瘤手术病例中有2例出现自发性鼻漏。两名患者均患有侵袭性泌乳素瘤。在这两个病例中，通过经蝶窦手术暴露缺损并用阔筋膜进行封闭。
紧急手术修复漏口预防了脑膜炎。在其中1例中，由于术后对残留肿瘤进行多巴胺激动剂治疗时出现反复鼻漏，需要进行二次手术。否则临床过程无并发症。
某些临床情况仍需要对泌乳素瘤进行初次手术治疗。侵袭性大泌乳素瘤引起的自发性鼻漏是初次手术的强制性指征。早期发现并手术修复脑脊液漏对于获得良好的临床结果至关重要。
