溴隐亭治疗垂体泌乳素腺瘤后并发脑脊液漏处理二例报道并文献复习

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

目的探讨溴隐亭治疗侵袭性垂体泌乳素腺瘤后并发脑脊液漏的原因、临床表现及处理方法。方法分析中山大学附属第三医院神经外科收治的2例溴隐亭治疗后并发脑脊液漏的垂体泌乳素腺瘤患者的临床资料，并复习相关文献。结果2例肿瘤均广。泛侵犯颅底，在溴隐亭治疗后1个月内发生脑脊液漏。1例经停药及脑室外引流处理后脑脊液漏停止．另一例经停药、经蝶手术修复漏口及腰大池置管外引流后脑脊液漏停止。在脑脊液漏好转2周后均继续予以较小剂量溴隐亭治疗，随诊3年和9个月无脑脊液漏复发，血泌乳素水平渐下降，肿瘤渐缩小。结论溴隐亭治疗合并颅底破坏的垂体泌乳素腺瘤时有并发脑脊液漏的可能。停药、手术修复漏口及肺脊液外引流是治疗此类并发症的有效方法。继续小剂量溴隐亭治疗可使肿瘤缓慢缩小并减少脑脊液漏发生的可能。

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 ventricular 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 ofbromocriptine 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.