Pseudo-cerebrospinal fluid rhinorrhea following endoscopic endonasal transsphenoidal surgery for PitNET: a case report and literature review.

Pseudo-cerebrospinal fluid (CSF) rhinorrhea, defined as non-CSF nasal discharge mimicking true CSF leakage, is a rare but clinically significant complication that may prompt unnecessary aggressive treatment. We report a case of a 64-year-old man who developed positional clear nasal discharge after endoscopic endonasal resection of recurrent pituitary neuroendocrine tumor (PitNET). Glucose oxidase testing was negative, and imaging demonstrated intact skull base reconstruction. Nasal endoscopy revealed bilateral crusting and purulent secretions without evidence of CSF leak. The condition was diagnosed as vasomotor rhinitis. Conservative management-including nasal debridement, antibiotic therapy, topical corticosteroids, and saline irrigation-led to complete symptom resolution. This case underscores the importance of differentiating pseudo-CSF rhinorrhea from true CSF rhinorrhea to avoid invasive interventions.