Cerebrospinal fluid rhinorrhea: evaluation with metrizamide cisternography

Abstract

Metrizamide computed tomog r aphic cist ernography was used to e xamin e 27 pat ient s (19 males and eight f emales , 14-59 years old) clinicall y suspected o f having ce rebrospinal f luid fist ulae with rhinorrhea. Twenty-one fi stulae were t rau matic and si x w ere spontaneous. Five t o 6 ml of metrizam ide (or lopamidol , t wo cases) were inject ed by lumbar puncture at a concentra t ion of 185-200 mg I/ ml f or direct corona l and ax ial computed tomographic sections o f the skull base. Cerebrospin al fluid rhinorrh ea w as p resent at the time of e xamination in 12 of 27 cases. Results were evalu ated according to three criteria: (1) metrizamide passage th rough t he bony and dural def ect; (2) demonstrable site of t he fracture and / or bony defect; and (3) metrizamide vi sualized within a paranasal sinus, nasal cavity, or cotton p ledget. T he e xam inat ion was considered positive when criterion 1 alone was present and when 2 and 3 we re associated. In 15 o f 27 cases, cisternography was posit ive, wit h t he e xact site of cerebrospinal f luid leakage demonstrated in 10 patients. In si x cases, t he result s were not defi nitive; only one of the criteria (2 or 3) was fulfilled. In si x cases, cisternog raphy w as normal. Seventeen patients underwent surgery. The site of cerebrospinal f ist ulae w as et hmoidal in nine cases, frontoet hmoidal in seven , sphenoidal in t wo, and sphenoethmoidal in one. The relative value of metrizamide computed tomographic cist ernography compared with ot her diagnostic st udies, poly tomography, positive or negative contrast studies, and radionuclides , is discussed. Diagnost ic pitfalls include art ifacts and partia l volume effect.

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

“…[18] In a study conducted on twenty-four patients, MRI has been reported to be 100% sensitive in demonstrating CSF leaks. [19] In an extensive review, all of the CSF leaks detected through MRI have been surgically verified. [3] In our study, CT cisternography was used to show CSF leaks, which were detected at a high rate.…”

Silla turca vacía primaria: clínica, fisiopatología y tratamiento

“…Se mantiene al paciente con la cabeza abajo, para facilitar el paso del contraste hacia los espacios subaracnoideos de la base de cráneo y se obtienen cortes coronales continuos de 1-3 mm de grueso. La prueba tiene una efectividad del 30-65%, que se incrementa hasta el 85-100% si se realiza durante el periodo de fístula activa 3,68 . Tiene los inconvenientes de un método invasivo y que provoca efectos secundarios tales como cefalea (38%), náuseas y vómitos (38%), que suelen remitir en menos de 24h 68 .…”

“…La prueba tiene una efectividad del 30-65%, que se incrementa hasta el 85-100% si se realiza durante el periodo de fístula activa 3,68 . Tiene los inconvenientes de un método invasivo y que provoca efectos secundarios tales como cefalea (38%), náuseas y vómitos (38%), que suelen remitir en menos de 24h 68 . Los artefactos metálicos a partir de ortodoncias o prótesis, degradan la calidad del estudio.…”

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

“…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.…”

“…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][8][9][10][11][12] MR imaging with T2-weighted sequences has been used to localize CSF fistulas.…”