Primary Empty Sella Syndrome Presenting with CSF Rhinorrhea: Successful Endoscopic Repair

Primary empty sella syndrome (ESS) is characterized by herniation of the subarachnoid space into the sella turcica with pituitary flattening. While usually asymptomatic, primary ESS can rarely present with cerebrospinal fluid (CSF) rhinorrhea. We report the case of a 67-year-old man with a 3-month history of headache and left-sided clear nasal discharge. Neurological and ophthalmological examinations were normal. Brain magnetic resonance imaging (MRI) revealed an empty sella. Endocrinological tests were within normal limits. An endoscopic transnasal transsphenoidal repair was performed using autologous fat grafting, resulting in complete resolution of symptoms. CSF leaks in ESS are often attributed to elevated intracranial pressure and diaphragmatic incompetence, leading to sellar floor erosion. Endoscopic repair offers a minimally invasive approach with high success rates and low morbidity. In cases of ESS complicated by CSF rhinorrhea, surgical repair is mandatory. The endoscopic transnasal transsphenoidal approach remains the preferred treatment option.