CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

Abstract

BACKGROUND AND PURPOSE:Skull base defects can result in CSF leaks, with meningitis as a potential complication. Surgeons are now routinely repairing these leaks via a nasal endoscopic approach. Accurate preoperative imaging is essential for surgical planning. A variety of imaging regimens have been employed, including axial and direct coronal CT, CT cisternography with iodinated contrast, radionuclide cisternography, and MR imaging. Now that multidetector helical CT is available, the purpose of this study was to determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks.

The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea

“…This protein is specific for CSF, and a small amount of rhinal discharge (0.4 ml) is adequate for the evaluation [1]. Glucose and protein level measurements made in the past are no longer carried out in many institutions [11].…”

“…Rhinorrhoea can be described as the leakage of CSF to the nasal cavity from a defect in the subarachnoid space [1,10]. This abnormal drainage route can cause serious complications, such as meningitis or abscesses [9].…”

“…The aetiology consists of trauma, endoscopic surgery, congenital defects (meningocele, meningoencephalocele and skull base malformations), hydrocephalus and erosions (the last two owing to tumour or infection) [10]. It can also occur spontaneously [1,11]. The leak after trauma usually resolves spontaneously without any intervention [4].…”

“…meningitis, unless treated properly [1]. A CSF fistula can cause rhinorrhoea if it causes a communication between the subarachnoid space and sinonasal cavity.…”

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

“…High-resolution CT, cisternography, and MRI CISS 3D protocols are then used to locate the site of CSF leak. 17,28 In the current NIS database study, for 50.3% of admissions in which the patients were reported to have CSF rhinorrhea and 64.1% of those in which they were reported to have CSF otorrhea, no skull or facial fracture was reported. Posttraumatic CSF rhinorrhea and otorrhea incidence increases after trauma to the frontal, ethmoid, and sphenoid bones.…”