Nasal discharge after transphenoidal pituitary surgery - normal or CSF leak?

[vegachka]

Hi, I had endoscopic transphenoidal surgery performed to remove a pituitary macro-adenoma on 11/29/10. The surgeons (ENT and Neuro) say the surgery went very well and they did not see or suspect a CSF leak. I had a LOT of bloody discharge after the surgery for close to two weeks, which the surgeons assured me was normal. Headaches went away a week after surgery but resumed, along with nose pain, after I started to sneeze about two weeks after surgery. I'm now almost three weeks out and sneeze (cannot stop it, no matter how much I try) 2-3 times a day. This causes pain in my nose, a slight headache, which tylenol relieves, and I continue to have nasal discharge but now it's not bloody, it's clear. There's no post nasal drip, no salty or metallic aftertaste, the headaches are much better and infrequent, I feel fine standing up and lying down, and the discharge is not constant but has me worried. I saw my ENT a week after surgery and he wasn't concerned. I will see him in three days again (three weeks post surgery). I think I just caught a cold - hence the sneezing, but I wanted to get others' thoughts as well. What do you think?

For those of you who had surgery through the nose, waht was your recovery like?

Thank you!
Lana

[vegachka]

Hi, Dr. Sharma. Thanks for your response. How long is it to have normal discharge for? I also feel like I caught a cold, as I've been sneezing and seem to have a runny nose. Is that possible, or does it really like sound like a CSF leak?

I definitely don't have headache, and the discharge is on and off. I went outside today, in the cold air, and felt more discharge than before. Shouldn't the discharge be persistent? Should I also have the salty taste in the back of my throat? Is the headache a must?

Thank you!

[Dr Sharma]

Hi there.  Post operatively after the transphenoidal pituitary surgery, one is questioned about rhinorhea apart from screening for cranial nerve function abnormalities. Some nasal drainage is expected in the post operative period but suspicious drainage ex. continuous fluid leakage exacerbated by leaning forward, associated with headache should be further investigated. Drainage may be collected and sent to the laboratory for examoination, for T-transferrin. If fluid tests positive for this, the diagnosis of CSF leakage is supported. Operative repacking of the defect with autologous fat best treats postoperative CSF leakage. Take care.