Evaluation of CSF Rhinorrhea by Computerized Tomography with Metrizamide

Chow, James M.; Goodman, David A.; Mafee, Mahmood F.

doi:10.1177/019459988910000204

Cited by 52 publications

(24 citation statements)

References 19 publications

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“…3 When active leaks were present, CT cisternography provided positive results in 85% of patients. 27 However, in cases of inactive fistulas, CT cisternography failed to recognize the site of leakage in 27.7% 28 and in 19% of patients. 29 Advances in CT and MR imaging techniques have improved sensitivity, which amounted to 88.25% 30 and 93% 31 for high-resolution CT and for MR cisternography to 89%, 6,31 93.6%, 28 and 100% 32,33 even in patients with inactive leaks.…”

mentioning

confidence: 99%

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Schuknecht¹,

Simmen²,

Briner³

et al. 2007

AJNR Am J Neuroradiol

147

135

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confidence: 99%

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Schuknecht¹,

Simmen²,

Briner³

et al. 2007

AJNR Am J Neuroradiol

147

135

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“…[16,17] MRI shows the cerebral tissue and soft tissue thoroughly, which is especially important in case of encephalocele. [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.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

Deveci

Uysal

Varol

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…CTC is accepted as the most accurate method for the investigation of active cranial CSF leakage, but it has a number of disadvantages. The sensitivity of CTC ranges between 72% and 81%, 3,25 and CTC may have problems in detecting lowflow fistulas or fistulas with only hairlike communications. This is because iodinated contrast media do not distribute freely in the CSF spaces due to their tendency to form sediment or because the tiny amount of dilute contrast medium that leaks through a fistula cannot be distinguished from the surrounding bone.…”

Section: Discussionmentioning

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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Evaluation of CSF Rhinorrhea by Computerized Tomography with Metrizamide

Cited by 52 publications

References 19 publications

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

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

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