Cerebrospinal Rhinorrhea with Pituitary Tumors

SINCE the first description of cerebrospinal rhinorrhea by Willis in 1676,l the condition has been reported following trauma (both accidental and surgical), infections of the nose and of the paranasal sinuses, congenital anomalies, and brain tumors. The term “spontaneous, primary, or idiopathic” rhinorrhea was at first applied to all but the posttraumatic cases,Z but more recently3 it has been restricted to instances where osseous defects, chiefly in the region of the cribriform plate and presumably of congenital origin, were demonstrable at surgery or at postmortem examination. The escape of cerebrospinal fluid from the nose represents numerically only a medical curiosity. Nevertheless, this condition constitutes a challenging therapeutic problem from both medical and surgical standpoints, since once a pathway has become established between the subarachnoid space and the outside world, the danger of meningitis, as well as of spontaneous pneumocephalus, is forever present. The etiologic agents have included the pneumococcus, staphylococcus, non-hemolytic streptococcus, and hemophilus, which gained access to the cranial cavity whenever the intracranial pressure had shifted in the direction of greater negativity (coughing, sneezing, nose-blowing) .