Imaging of Cerebrospinal Fluid Leaks*

Hofmann, Erich; Behr, Robert; Schwager, K.

doi:10.1007/s00062-009-9008-x

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…[5][6][7][8] Prior to surgical management, computed tomography (CT) or magnetic resonance imaging (MRI) have been proven to be highly effective in localising leak sites to aid subsequent planning of surgical approach and repair technique. 5,7,9 Inability to localise the site prior to surgery is associated with surgical failure. 10 In cases of iatrogenic CSF leaks following large skull base resections, early identification and robust multilayer reconstruction remains the mainstay of management.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks

Jolly

Gupta

Banota

et al. 2021

Am J Rhinol�Allergy

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Background Cerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates >90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed. Objective Evaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre. Methods All patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 – September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospectively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety). Results There were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities. Conclusion Many studies have demonstrated IF to be safe at low doses (<50mg) with a high sensitivity, specificity and positive predicative value. Our results demonstrate that the use of IF in our centre is safe and effective at identifying CSF fistulae. While we have reported some complications in our cohort, these were unlikely to be directly attributable IF use. We have described no serious complications such as seizures, limb weakness or death. We believe this study adds to the growing body of evidence that IF use in the management CSF fistula repairs is safe and effective.

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Section: Introductionmentioning

confidence: 99%

The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks

Jolly

Gupta

Banota

et al. 2021

Am J Rhinol�Allergy

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“…Especially in cases with intermittent leak during inactive periods, it may be problematic to determine the exact leakage site (6). Among the many techniques, CT cisternography stands out as an old but reliable way to detect the leakage and its location.…”

Section: █ Discussionmentioning

confidence: 99%

“…Computerized tomography (CT) or contrast-enhanced CT may confirm CSF leak and the exact place of the leakage (28). While magnetic resonance imaging (MRI) is effective in determining the abnormalities of some soft tissues like tumor and meningo-encephalocele, it is inefficient in showing bone fractures and defects (6,13). The main goal of the surgical treatments performed in spontaneous rhinorrhea both extra-cranially and intra-cranially has been to repair the defect.…”

mentioning

confidence: 99%

The results of the surgical treatment of spontaneous rhinorrhea via craniotomy and the contribution of CT cisternography to detection of exact leakage site of csf

Tümtürk¹,

Ulutabanca²,

Gökoğlu³

et al. 2015

Turkish Neurosurgery

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The majority of CSF leaks are posttraumatic (80%) or postoperative/iatrogenic (16%) and only 4 % are spontaneous (2). Spontaneous or primary CSF fistulas have been accepted as a different entity, seen in patients without any known etiologic factors such as a tumor, trauma or congenital anomalies. It is generally seen in the middle-aged obese women (10,20).In the presence of a nasal secretion and a suspicion of CSF leak, the nasal fluid must be examined for the possibility of CSF. For this purpose, diagnostic procedures based on structural differences of bodily fluids are used in certain █ INTRODUCTION C erebrospinal fluid (CSF) leak or cerebrospinal fistula is a medical condition described first by St. Clair Thompson, in which the CSF leaks out of intracranial cavity due to the presence of defects in the dura on the skull base (1). It suggests a laceration or defect in the dura, arachnoid and pia mater, causing a communication between intracranial cavity and nasal or tympanic cavity (13). Cribriform plate is the area where CSF leak often occurs, followed in terms of frequency by sella, sphenoid, ethmoid and frontal sinuses (7,29). AIM:To share the results of conventional surgery in rhinorrhea and the contribution of computerized tomography (CT) cisternography to determination of the site of cerebrospinal fluid (CSF) leak. MATERIAL and METhODS:Twelve cases treated for spontaneous rhinorrhea were included in this study. All the cases underwent cranial CT and magnetic resonance imaging (MRI). CT cisternography was performed in four patients whose bone defect or leakage site could not be detected by CT and MRI. In order to repair the defect, either the galea or galea together with collagen matrix was used and the procedure was supported with fibrin glue. RESULTS:In the cases, postoperative rhinorrhea was seen in neither the early nor the late follow up period. We observed no complications related to CT cisternography or craniotomy. The leakage area was successfully detected with CT cisternography when the other methods failed. CONCLUSION:Bone defect can usually be shown by means of CT. However, when bone-defect cannot be shown or the dura in the defective area is intact, CT cisternography is useful to show the CSF leak. Conventional surgery was very succesful in the treatment of spontaneous rhinorrhea but it was cosmetically problematic. In the patients both treated with galea and galea together with collagen matrix, the repair of the defect was successful.

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“…Traumatic cerebrospinal leakage is a complication seen in 2% of all head-injured patients and in 12-30% of cases of basilar skull fractures [49]. The most common locations are the cribriform plate (forming the roof of the ethmoid) and the walls of the frontal sinus [50]. Intracranial air may be an important sign.…”

Section: Traumatic Csf Leaksmentioning

confidence: 99%

Traumatic Neuroemergency: Imaging Patients with Traumatic Brain Injury—An Introduction

Parizel

Philips

2020

IDKD Springer Series

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Learning Objectives • Understand the role of imaging in the urgent evaluation of patients with CNS trauma • Review common surgical vs. non-surgical CNS abnormalities in trauma patients • Compare MR and CT for evaluation of brain trauma Key Points • CT has become the most important diagnostic test in patients with CNS trauma in the urgent setting. • CT has the ability to depict traumatic lesions that will require urgent surgical management and to also assess other traumatic lesions that are notable but not surgical indications. • MR can accurately detect a range of CNS injuries that are ultimately critical in the prognosis of major CNS trauma.

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Imaging of Cerebrospinal Fluid Leaks*

Cited by 12 publications

References 35 publications

The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks

The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks

The results of the surgical treatment of spontaneous rhinorrhea via craniotomy and the contribution of CT cisternography to detection of exact leakage site of csf

Traumatic Neuroemergency: Imaging Patients with Traumatic Brain Injury—An Introduction

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