Cebrospinal fluid leakage in prolactinoma patients during dopamine agonists treatment

Abstract

Objective – to identify medical tactics in patients with cerebrospinal fluid leakage (CSFL), which occurred against the background of conservative treatment prolactinomas (PRL) by dopamine agonist (DA).

Materials and methods. 178 primaries PRL were diagnosed in department of transsphenoidal neurosurgery Institute of Neurosurgery during 2015-2016 years. In 134 (75.3 %) patients conservative treatment was conducted under the observation of an endocrinologist and neurosurgeon. The 16 cases were initially held surgical treatment (with cystic PRL, cases with pituitary apoplexy, intolerance to DA). Another 28 (15.7 %) patients were conducted surgery for resistance to treatment of DA during the first 6-12 months of diagnosis.

Results. Macroadenomas with invasive extrasellar extention amounted to 78.4 % primarily nonsurgical cases (n = 105). In 3 patients with large-invasive PRL spontaneous CSFL arose during the treatment with DA. In clarifying history of disease we found out that in one patient the episode of CSFL was the primary symptom of disease before starting the conservative treatment. However intensification of CSFL and the need of surgical treatment emerged later. All patients were performed long-term (up to 10-14 days) external lumbar drainage, which was enough in 2 cases and conservative treatment was successfully continued. In one case, the CSFL was profuse and did not react to drainage with futher endoscopic endonasal tumor remove and dural defects plasty. Spontaneous CSFL is possible with bone-destructive PRL extensions as the onset of the disease, and, most importantly, against the background of rapid tumor reduction in the conservative treatment of DA. Surgical treatment of these cases has a high difficulty due to the need for CSFL plastic only after the tumor is removed.

Conclusions. The incidence of CSFL on the background of conservative treatment of PRL is 2.2 %. In identifying the CSFL should use long-term external lumbar drainage without interrupting basic treatment of DA, and only after ineffectiveness of last perform surgery