{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T21:36:21Z","timestamp":1783460181540,"version":"3.55.0"},"reference-count":24,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare. The objective of this study is to report two rare cases of pituitary adenoma with spontaneous CSF rhinorrhea successfully operated by endoscopic transsphenoidal approach with vascularized nasoseptal flap (NSF).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 70-year-old woman presented with a 6-month history of watery rhinorrhea and posterior nasal drip that worsened when her head leaning forward. Sella magnetic resonance image (MRI) demonstrated pituitary macroadenoma (3.4 \u00d7 2.7 cm) invading cavernous sinus, clivus, and sphenoid sinus. A 47-year-old woman presented with a 10-month history of watery rhinorrhea and posterior nasal drip. Sella MRI demonstrated pituitary macroadenoma (6.3 \u00d7 4.6 cm) invading cavernous sinus, clivus, sphenoid sinus, and middle fossa. Both patients underwent endoscopic endonasal transsphenoidal operation and skull base reconstruction with vascularized NSF. The postoperative clinical course was uneventful and CSF rhinorrhea disappeared completely.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Pituitary adenoma should be suspected if there is a watery CSF rhinorrhea that occurs without a history of trauma or nasal disease. In addition, effective treatment can be performed using NSF, a technique for endoscopic skull base reconstruction.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_61_2022","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T08:32:33Z","timestamp":1656059553000},"page":"262","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports"],"prefix":"10.25259","volume":"13","author":[{"given":"Beom Mo","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuk-Jin","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang-Hui","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Min","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"10.25259\/SNI_61_2022\/ref-1","first-page":"347","article-title":"Transient cerebrospinal fluid rhinorrhea, blurred vision, and headache as presenting symptoms of pituitary adenoma","volume":"4","author":"Bell","year":"1991","journal-title":"J Am Board Fam Pract"},{"key":"10.25259\/SNI_61_2022\/ref-2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0303-8467(84)90278-6","article-title":"Rhinorrhoea as the presenting symptom of pituitary adenoma","volume":"86","author":"Bilo","year":"1984","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_61_2022\/ref-3","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/000348948008900202","article-title":"Extracranial surgical repair of cerebrospinal rhinorrhea","volume":"89","author":"Calcaterra","year":"1980","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10.25259\/SNI_61_2022\/ref-4","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1177\/019459989110400316","article-title":"Spontaneous CSF rhinorrhea: An unusual presentation of a pituitary adenoma","volume":"104","author":"Carroll","year":"1991","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10.25259\/SNI_61_2022\/ref-5","first-page":"E5","article-title":"Extended endoscopic endonasal approach to the pterygopalatine fossa: Anatomical study and clinical considerations","volume":"19","author":"Cavallo","year":"2005","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI_61_2022\/ref-6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/02688697.2019.1587384","article-title":"Spontaneous cerebrospinal fluid rhinorrhea associated with an incidental pituitary adenoma","volume":"20","author":"Chu","year":"2019","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_61_2022\/ref-7","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/014107688007300407","article-title":"Cerebrospinal fluid rhinorrhoea in pituitary tumours","volume":"73","author":"Cole","year":"1980","journal-title":"J R Soc Med"},{"key":"10.25259\/SNI_61_2022\/ref-8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/000348949610500413","article-title":"Demonstration of the nasal septal branches of the sphenopalatine artery by use of a new intravascular injection method","volume":"105","author":"Fujii","year":"1996","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10.25259\/SNI_61_2022\/ref-9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/BF01793131","article-title":"Cerebrospinal rhinorrhea with pituitary adenoma. 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