Cerebrospinal fluid rhinorrhea demonstrated by metrizamide CT cisternography

Drayer, B P; Wilkins, Robert H.; Boehnke, Manfred; Horton, JA; Rosenbaum, A. E.

doi:10.2214/ajr.129.1.149

Cited by 76 publications

(24 citation statements)

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“…The technique of investigation and the results have been described by numerous authors 13, 14,16,37,38,67,75 In our experience, the CSF fistula thus becomes directly visible in many patients, (especially in simulteaneous presence of CSF rhinorrhea). Occasionally, basal escape of contrast medium in a traumatic pseudomeningocoele with sacculate delimitation can also be imaged in the absence of CSF rhinorrhea.…”

Section: Diagnostic Advancesmentioning

confidence: 56%

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Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967–1989)

Probst

1990

Acta neurochir

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300 patients with traumatic fronto-basal CSF fistulae were treated neurosurgically from 1967 to 1989, i.e. via a transcranial approach. An additional intracranial space occupying lesion, a direct open endocranium and/or a large basal brain hernia was found in 68%. The following aspects were discussed: progress in establishing the exact anatomical diagnosis, especially neuroradiological advances; questions of the indication for surgery; the problem of the optimal surgical approach. Both the cranial and the rhinological approach have advantages and disadvantages. Their indications only partly coincide, so that the choice of method depends especially on the individual pathology. Advances were made in recent years in terms of neurosurgery as well as of rhinology. The neurosurgical results could be improved, and postoperative complications have become rare after the cranial approach. Besides the optimal choice of the time of operation, the following factors are important: an adequate intracranial debridement; a microsurgical technique entailing as little damage to surrounding tissue as possible and various specially mentioned brain-protective measures. An optimal collaboration between the specialties involved is the basis for further progress. More attention must be paid to endocrinological problems in the future.

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Section: Diagnostic Advancesmentioning

confidence: 56%

“…An arteriovenous fistula occurred in the region of the sinus cavernosus in one case. (30) (29) (31) (14) (5) (4) …”

Section: Generalmentioning

confidence: 99%

Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967–1989)

Probst

1990

Acta neurochir

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“…10 O papel da cisternotomografia com contraste hidrossolúvel não-iônico (metrizamida) na rinoliquorréia foi estabelecido primeiramente por Drayer. 17 Subseqüentemente, este método se mostrou eficiente em várias publicações. [18][19][20] Atualmente é considerado o método de escolha no topodiagnóstico da FL.…”

Section: Discussionunclassified

Avaliação da tomografia computadorizada e da cisternotomografia computadorizada com Lopamidol no topodiagnóstico da fístula liquórica e comparação com os achados cirúrgicos

Guimarães¹,

Becker²,

Becker³

et al. 2004

Rev. Bras. Otorrinolaringol.

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Evaluation of computerized tomography and computed tomographic Lopamidol cisternography on the topographic diagnosis of cerebrospinal fluid rhinorrhea and comparison with surgical findings Resumo / SummaryDesde que a abordagem por via microendoscópica nasal se tornou uma rotina no tratamento da fístula liquórica da base anterior do crânio, a necessidade do topodiagnóstico preciso aumentou grandemente. A localização pré-operatória da fistula com métodos de imagem torna o ato cirúrgico mais rápido e direcionado. Objetivo: O objetivo deste estudo é avaliar a eficá-cia da cisternotomografia (CTG) e da tomografia computadorizada (TC) na localização da fístula liquórica de acordo com os achados cirúrgicos. Forma de Estudo: Observacional coorte com corte transversal. Material e Método: Quarenta e seis pacientes com diagnóstico clínico de fístula liquórica foram avaliados com TC, e destes, 38 também foram submetidos à CTG contrastada com Lopamidol. Resultado: A cisternotomografia apontou corretamente o local exato da fístula em 71% dos casos enquanto a tomografia o fez em 52% destes. A cisternotomografia foi importante na localização da fístula em 84,15%. Conclusão: Ainda não há um método considerado padrão de referência no topodiagnóstico da fístula liquórica. Nesse propósito a CTG com Lopamidol é um método valoroso.

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“…5,6 Numerous techniques, including plain skull radiography, intraoperative injection of fluorescein dye, positive contrast (iophendylate) studies, and radionuclide cisternography, are all helpful in limited ways. [7][8][9][10][11][12] MR imaging with T2-weighted sequences has been used to localize CSF fistulas. The demonstration of high-signal-intensity fluid extending from the subarachnoid space directly into the adjacent paranasal sinuses or herniation of the brain into a sinus through a bone defect has been the principal diagnostic criterion.…”

mentioning

confidence: 99%

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

Selçuk¹,

Albayram²,

Özer³

et al. 2009

AJNR Am J Neuroradiol

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BACKROUND AND PURPOSE:Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. MATERIALS AND METHODS:A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. RESULTS:We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into Ͼ1 paranasal sinus.CONCLUSIONS: MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas. CSF leakage implies abnormal communication between the subarachnoid space and the nasal or middle ear cavity. It is generally classified as traumatic, nontraumatic (ie, spontaneous), or postsurgical in origin, 1 and most cases are traumatic. Approximately 70% of traumatic CSF fistulas close spontaneously within 1 week after injury without surgical intervention.2-4 However, even in cases of mild CSF rhinorrhea or early spontaneous closure, patients remain at risk of recurrent CSF leakage, pneumocephalus, and infectious meningitis. Precise identification of the location of the CSF fistula allows proper surgical planning, increases the chance of dural repair, and can prevent complications. 5,6 Numerous techniques, including plain skull radiography, intraoperative injection of fluorescein dye, positive contrast (iophendylate) studies, and radionuclide cisternography, are all helpful in limited ways.7-12 MR imaging with T2-weighted sequences has been used to localize CSF fistulas. The demonstration of high-signal-intensity fluid extending from the subarachnoid space directly into the adjacent paranasal sinuses or herniation of the brain into a sinus through a bone defect has been the principal diagnostic criterion.2,13-18 However, some or all of these findings can occasionally be observed in the absence of fistula formation on MR images obtained for reasons other than CSF leakage. The most common method for evaluating a patient with suspected CSF rhinorrhea is a combination of thin-section CT and subsequent CT cisternography (CTC). Although high-resolution CT (HRCT) is sufficient to show bony defects in the skull base...

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Cerebrospinal fluid rhinorrhea demonstrated by metrizamide CT cisternography

Cited by 76 publications

References 4 publications

Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967–1989)

Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967–1989)

Avaliação da tomografia computadorizada e da cisternotomografia computadorizada com Lopamidol no topodiagnóstico da fístula liquórica e comparação com os achados cirúrgicos

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

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