Hormonal Fertility Therapy as Potential Risk Factor for Cerebrospinal Fluid Leak After Endoscopic Endonasal Surgery:...

Endoscopic endonasal approaches have been shown to be as effective as transcranial approaches for sinonasal malignancies involving the skull base. Although they are associated with less risk than an open cranial resection, cerebrospinal fluid (CSF) leaks remain a main concern. Some drugs can raise the intracranial pressure and exacerbate the risk of a postoperative CSF leak. In this case report, we present a 32-year-old woman who was treated via endoscopic endonasal approach for an olfactory neuroblastoma and later underwent fertility preservation treatment with leuprolide, which likely led to a delayed CSF leak.

A 32-year-old woman diagnosed with a large invasive olfactory neuroblastoma underwent resection via an endonasal transcribriform approach and repair of skull base defect using a pericranial flap. Forty-seven days post operation the patient returned, presenting with a clear nasal discharge. Magnetic resonance imaging raised concern for focal flap necrosis, while computed tomography cisternogram revealed a defect in the pericranial flap. The defect was debrided and repaired; a postoperative lumbar drain was placed and showed an opening pressure of 26 cm of water. Discussion with the patient revealed that she received fertility preservation treatment with leuprolide followed by oocyte retrieval 32 days before presentation of her delayed CSF leak.

Leuprolide or any drug that can potentially increase intracranial pressure should be held for 3 months after surgery or until after a skull base defect has fully healed.