Management of cerebrospinal fluid leakage following treatment of prolactinomas with bromocriptine:a report of 2 cases and literature review

Abstract

Objective To investigate the causes,clinical manifestations and treatments of cerebrospinal fluid(CSF)leakage following the treatment of prolactinomas with bromocriptine.Methods The data of 2 patients with prolactinomas and CSF leakage following bromocriptine treatment,were retrospectively analyzed and the associated literatures were reviewed.Results Two patients with massive invasive prolactinomas eroding the skull base developed CSF leakage within 1 month after commencing bromocriptine treatment.Bromocriptine treatment was stopped and external ventficular drainage was performed in 1.Bromocriptine treatment was stopped and transsphenoidal surgery in debulking the tumor and sealing the leakage with fibrin glue was performed in the other patient.The bromocriptine treatment was resumed with a lower dose in both patients and the CSF leakage never recurred in the follow-up of 9-36 months;the serum prolactin decreased and the tumor shrank gradually.Conclusions CSF leakage may develop in bromocriptine-treated patients with invasive prolactinoma eroding skull base.Surgical repair of the fistula,withdrawal of bromoeriptine and additional external CSF drainage are the effective ways in treating CSF leakage.Resuming bromocriptine treatment with a lower dose can induce gradual decrease of the serum prolactin and shrink of the tumor. Key words: Bromocriptine; Cerebrospinal fluid leakage; Invasive prolactinoma