Relationship Between Benign Intracranial Tumor Location and the Side of Spontaneous Cerebrospinal Fluid Leak

AIM: To present cases of spontaneous cerebrospinal fluid (CSF) rhinorrhea and otorrhea, and to conduct a systematic literature review examining the relationship between benign tumor location and the leak side. MATERIAL and METHODS: A PRISMA-based systematic review was conducted to evaluate studies on spontaneous CSF leaks caused by benign intracranial tumors, alongside three newly reported cases.

Results

All three cases exhibited CSF leaks ipsilateral to the tumor: Case 1 involved a pituitary ACTH-secreting macroadenoma with rhinorrhea; Case 2, a pineocytoma with hydrocephalus and nasal encephalocele; and Case 3, a petromastoid meningioma with otorrhea. In the systematic literature review, 28 of 125 studies met the inclusion criteria. The median patient age was 42 years, with a male-to-female ratio of 16:12. Macroprolactinoma was the most frequent tumor (25%), primarily located in the sella (46.4%). Tumors were located at the midline (39.3%), right side (35.7%), or left side (25%). The sphenoid sinus was the most common site of CSF leak (39.3%). The leak occurred through the right nostril (39.3%), left nostril (39.3%), both nostrils (10.7%), right ear (7.1%), and both the nostril and ear (3.5%). Hydrocephalus was present in 25% of cases.