ReviewBrain & spine2026
When treatment backfires: Dopamine agonist-induced CSF leaks in prolactinomas - Case series and systematic review.
Review in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
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Abstract
Introduction: Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially life-threatening complication of dopamine agonist (DA) therapy in patients with invasive macroprolactinomas. Research question: To identify clinical and anatomical risk factors for DA-induced CSF rhinorrhea and to evaluate effective surgical management strategies in patients with prolactinomas. Material and methods: We retrospectively reviewed two adult male patients treated at our center who developed CSF rhinorrhea following cabergoline therapy for prolactinomas. In parallel, a systematic literature review was conducted following PRISMA guidelines, including 105 patients from 38 studies published between 1982 and 2025. Data on demographics, tumor characteristics, prolactin levels, timing of CSF leak, and management strategies were analyzed. Results: Both patients developed CSF rhinorrhea 7-12 months after initiation of DA therapy. Imaging revealed sellar floor erosion. Endoscopic transsphenoidal surgery (ETSS) with sellar reconstruction using a vascularized nasoseptal flap was successfully performed. The postoperative course was uneventful, and no recurrence of CSF leak was observed during follow-up. Literature review confirmed a male predominance, a mean age of 45.6 years, frequent sphenoid sinus or sellar floor involvement and onset of CSF leaks predominantly within the first year of therapy. Endoscopic transsphenoidal multilayer reconstruction was the most employed and effective treatment modality across reported cases. Discussion and conclusion: DA-induced CSF rhinorrhea is associated with invasive tumor features and sphenoid sinus involvement. Early recognition and timely surgical intervention in specialized centers are critical to prevent serious complications. Patients receiving DAs should be counseled regarding this risk, and standardized endoscopic skull base reconstruction provides a safe and effective management strategy.
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