When does prolactinoma require neurosurgical intervention?

Patients with macroprolactinoma (MPRL) resistant to dopamine agonists and its rare complications, such as CSF rhinorrhea is rarely seen by physicians.This report presents a clinical case of a 51-year-old female with MPRL complicated by CSF leakage.She had been experiencing visual impairment and headaches for six months.The diagnosis of MPRL was made based on serum prolactin level and MRI images.After three months of cabergoline treatment, a follow-up MRI scan revealed tumor shrinkage.However, the patient developed CSF rhinorrhea, a severe complication requiring urgent surgical intervention.The main objective of the article is to discuss risk factors, diagnostic approaches, and therapeutic management of CSF rhinorrhea.