Cerebrospinal fluid rhinorrhea and the empty sella.

Abstract

C EREBROSPINAL fluid rhinorrhea is associated infrequently with abnormalties of the pituary fossa or sphenoid sinus. It has almost always been described in reference to tumor, cyst, infection, head injury, nasal or cranial operation, yttrium or x-ray therapy. The occurrence of cerebrospinal fluid rhinorrhea in the absence of the above and in the presence of an empty had not been reported in the English literature prior to June, 1968. At that time Ommaya, et al., reviewed 18 cases of nontraumatic rhinorrhea including two patients with empty sellas. ''16 One was a 57-year-old man with seizures and mild hypopituitarism, in whom pneumoencephalography and surgery showed that the anterior portion of the sella was empty. A second patient, mentioned only briefly, had an arachnoidal hernia through a hole in the floor of the sella. Both patients were operated on successfully for arrest of the rhinorrhea. The empty syndrome 3,9 usually refers to a rare late complication of radiotherapy for pituitary adenomas. Years after receiving radiation, these patients characteristically develop vision impairment, probably due either to involvement of the optic nerve and chiasm by dense scar tissue or radiation degeneration, without evidence of tumor recurrence. In our four new patients cerebrospinal fluid rhinorrhea was associated with leakage through an empty as verified at operation. None had received radiotherapy and in none was there any evidence of tumor.