Akinduro Oluwaseun O, Akinduro Olutomi T, Gupta Vivek, Reimer Ronald, Olomu Osarenoma
Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
University of Tennessee College of Medicine, Memphis, Tennessee, USA.
World Neurosurg. 2018 Apr;112:227-231. doi: 10.1016/j.wneu.2018.01.112. Epub 2018 Jan 31.
Prolactinomas may rarely present with meningitis and cerebrospinal fluid (CSF) rhinorrhea secondary to erosion of the wall of the sella turcica. It is even more uncommon for this abnormal communication to be caused by an ectopic prolactinoma arising from the sphenoid sinus and eroding into the sella. This atypical growth pattern makes diagnosis very difficult because there may be no displacement of the normal pituitary gland. The first reported case of a patient with an ectopic prolactinoma originating within the sphenoid sinus presenting primarily with meningitis is presented, and the management strategy and surgical and nonsurgical treatment options are discussed.
A 48-year-old woman presented with confusion, low-pressure headache, and fever. A lumbar puncture revealed Streptococcus pneumoniae meningitis, and she was placed on intravenous penicillin G. After initiation of antibiotics, she noticed salty tasting postnasal fluid leakage. Imaging was remarkable for bony erosion of the sphenoid sinus wall by a soft tissue mass growing from within the sinus, with no disruption of the normal pituitary gland. A biopsy was then performed with an endoscopic transnasal transsphenoidal approach, and the CSF leak was repaired with a pedicled nasoseptal flap. The final pathology was prolactinoma, and she was placed on cabergoline.
Ectopic prolactinomas may rarely present as meningitis secondary to retrograde transmission of bacteria through a bony defect in the sphenoid sinus, and must be included in the differential diagnosis of any sphenoid sinus mass. Management should first address the infection, followed by surgical repair of the bony defect.
催乳素瘤很少会表现为脑膜炎和继发于蝶鞍壁侵蚀的脑脊液鼻漏。由蝶窦产生并侵蚀入蝶鞍的异位催乳素瘤导致这种异常连通的情况更为罕见。这种非典型的生长模式使得诊断非常困难，因为正常垂体可能没有移位。本文介绍了首例主要表现为脑膜炎的起源于蝶窦内的异位催乳素瘤患者，并讨论了管理策略以及手术和非手术治疗方案。
一名48岁女性出现意识模糊、低压性头痛和发热。腰椎穿刺显示为肺炎链球菌脑膜炎，她接受了静脉注射青霉素G治疗。开始使用抗生素后，她注意到有咸味的鼻后液体漏出。影像学检查显示蝶窦内生长的软组织肿块导致蝶窦壁骨质侵蚀，正常垂体未受破坏。随后采用内镜经鼻蝶窦入路进行活检，并用带蒂鼻中隔瓣修复脑脊液漏。最终病理结果为催乳素瘤，她开始服用卡麦角林。
异位催乳素瘤很少会表现为细菌通过蝶窦骨质缺损逆行传播继发的脑膜炎，在任何蝶窦肿块的鉴别诊断中都必须考虑到。治疗应首先处理感染，然后对骨质缺损进行手术修复。
