Pathogenesis of non-traumatic cerebrospinal fluid rhinorrhea

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Abstract
Patients (15) with non-traumatic CSF rhinorrhea were studied. Operations (13) were performed on 10 patients. In 8 transcranial operations, an assumed defect in the anterior fossa was plugged with muscle, but only 3 operations were successful. In 4 operations, either transcranial or transsphenoidal; the sella was packed with muscle and rhinorrhea ceased immediately. Based on radiological and operative findings, 3 groups of patients appeared. Patients (9) had pathology related to the pituitary gland or the sella turcica; enlarged sella, empty sella, pituitary tumor, intrasellar cyst or erosion of the sellar osseous border. Patients (2) had rhinorrhea from extrasellar origin and in 4 patients no abnormality could be found. Prior to the rhinorrhea, 6 patients (5 from group 1 and 1 from group 3) had experienced episodes of neurological symptoms, compatible with a pituitary apoplexy. Non-traumatic CSF rhinorrhea in most cases is the result of a spontaneous necrosis in a pituitary adenoma, which has caused sellar bony erosion.