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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Cerebrospinal Fluid Leak After Treatment Of Pituitary Adenoma?

Hi, I am a sufferer of giant pituitary adenoma. After the treatment, I am suffering from CSF leak problems. In six months, I ve done CSF leak repairing surgery twice, but have yet to heal. Here is my situation: Oct.2011-- Water broken during pregnancy. After about 3 weeks, right eyelid ptosis and double vision. Nov.2011—The doctor has done the surgery on me in trillium hospital Mississauga. The surgery was successfully, a part of the tumor was removed. My eyelid and vision returned to normal. Mar.2013 --MRI found the tumor grew again. I were taking radiation treatment 25 times at Princess Margaret hospital during April to May. After treatment, tumor has shrunk small. Mar.2014—I suffered from CSF leak. The Doctor has done the craniotomy surgery on me. But unfortunately it was not successful. On July, the doctor has done another surgery on me through right nose hole. After the surgery, I was feeling good. But now I found it is leaking again. I really do not know who could help me. I would really appreciate if you could give me some advices or recommend someone who is good at CSF leak repairing in Ontario. Thank you! Jenny Song
Thu, 29 Jan 2015
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Radiologist,  's  Response
Hi,
Thanks for writing in.

The pituitary gland is located in the piuitary fossa region or sella which is located in the midline above and behind the eyes. Sugical approach to tumors of pituitary can involve through the skull as in craniotomy or through the nose. The chances of CSF leak are higher in the surgical approach through nose. During surgery for pituitary adenoma, the tumor is approached though the roof of the nose to reach the tumor. This is called trans sphenoidal surgerydone through the nose. Unavoidably, the surgery involves making a small aperture which connects the brain to the roof of nose. This is then sealed and should heal by itself in most patients. In a small group of people, this communication does not heal completely and might persist as a route through which CSF leak occurs.

Treatment of a CSF leak is done by surgical repair or in some cases through use of temporary diversion of CSF through a lumbar drain or a ventriculostomy (a catheter placed in the ventricle of the brain). Please discuss these options with your neurosurgeon.
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What Causes Cerebrospinal Fluid Leak After Treatment Of Pituitary Adenoma?

Hi, Thanks for writing in. The pituitary gland is located in the piuitary fossa region or sella which is located in the midline above and behind the eyes. Sugical approach to tumors of pituitary can involve through the skull as in craniotomy or through the nose. The chances of CSF leak are higher in the surgical approach through nose. During surgery for pituitary adenoma, the tumor is approached though the roof of the nose to reach the tumor. This is called trans sphenoidal surgerydone through the nose. Unavoidably, the surgery involves making a small aperture which connects the brain to the roof of nose. This is then sealed and should heal by itself in most patients. In a small group of people, this communication does not heal completely and might persist as a route through which CSF leak occurs. Treatment of a CSF leak is done by surgical repair or in some cases through use of temporary diversion of CSF through a lumbar drain or a ventriculostomy (a catheter placed in the ventricle of the brain). Please discuss these options with your neurosurgeon.