Some patients with pituitary tumors keep feeling fluid coming out of their nose after surgery and think they are sniffling. In fact, it is possible that a cerebrospinal fluid nasal leak has occurred. Cerebrospinal fluid is produced by the choroid plexus in the lateral ventricles and is a colorless, clear liquid that fills the ventricles, the subarachnoid space and the central canal of the spinal cord. Cerebrospinal fluid nourishes brain cells, transports metabolites from brain tissue, and regulates the acid-base balance of the central nervous system; it also cushions the pressure on brain tissue and the spinal cord, and has the function of protecting and supporting brain tissue and the spinal cord. (See below) Guo Hongchuan, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University During surgical removal of pituitary tumors, if the saddle septum of the arachnoid layer above the pituitary gland is broken cerebrospinal fluid will flow from the fistula down the nasal cavity, resulting in postoperative cerebrospinal fluid nasal leakage. If this occurs, prompt surgical repair is required. Usually, autologous tissue, such as mucosa from the nasal septum, is taken and patched to the fistula site. It is relatively rare for a nasal leak of cerebrospinal fluid to occur, but if it does, it must be repaired in a timely manner. If the repair is not done in time, the cranial cavity is connected to the outside world through the nasal cavity and intracranial infection is sure to occur. When intracranial infection occurs, on the one hand, the leak must be repaired immediately to prevent further aggravation of the infection; on the other hand, antibiotics must be administered. However, due to the protection of the blood-brain barrier, it is difficult for general antibiotics to enter the subarachnoid space to play an effective role. Therefore, the patient needs to undergo lumbar puncture or lumbar pool drainage to release some of the infected cerebrospinal fluid, and then intrathecal injection of antibiotics to ensure normal pressure and circulation of cerebrospinal fluid on the one hand, and sterilization and anti-inflammatory effects on the other. (See below.) Of course, intracranial infection is not always caused by cerebrospinal fluid nasal leakage, but may also be caused by prolonged surgical operation. Also, care should be taken to avoid the occurrence of hydrocephalus and intracranial hemorrhage. Generally speaking, these complications are very rare with the use of endoscopic resection of pituitary tumors. Of course, some patients may develop rhinitis or a poor sense of smell after surgery, although they do not have a “runny nose” like clear water. This is due to the fact that the nasal cavity is used as the surgical channel for endoscopic surgery, and the operation will cause some stimulation to the nasal mucosa. Don’t worry too much, this situation can be relieved by getting an ENT doctor to spray a certain amount of hormones. This article is authorized by Dr. Guo Hongchuan. Click on the related link for more details about “Pituitary Tumor: Surgery or Medicine? What if the pituitary gland is not cut cleanly or damaged after surgery? Post-operative follow-up to prevent pituitary tumors from coming back” “Dr. Guo Hongchuan’s guide to pituitary tumors