Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhoea

Abstract

Imaging is an important component in the investigation of unilateral watery rhinorrhoea suspicious of cerebrospinal uid (CSF). Whilst the demonstration of the presence of beta 2 transferrin con rms that CSF is present it may prove dif cult to demonstrate the exact site of origin. Fine detail coronal computed tomography (CT) with sections of 1-2.mm thickness through the anterior skull base may show small dehiscences and fractures. The commonest site for congenital dehiscences is the cribriform niche adjacent to the vertical attachment of the middle turbinate anteriorly and the superior and lateral walls of the sphenoid posteriorly. In the presence of frequent or constant CSF rhinorrhoea a CT cisternogram can be helpful in de ning the exact site of the leak. Magnetic resonance imaging (MRI) is reserved for de ning the nature of soft tissue i.e. in ammatory tissue, meningoencephalocele or tumour. Finally, per-operative intrathecal uorescein is helpful when imaging does not prove positive. A management algorithm for CSF rhinorrhoea is presented.

Cerebrospinal fluid rhinorrhea: endoscopic repair based on a combined diagnostic approach

“…So this should bring us to the conclusion that the diagnosis of CSF rhinorrhea should be based on a combination of laboratory and radiological evaluation with the use of intrathecal fl uorescein providing the fi nal proof of diagnosis and serving as an effective transoperative guide to closure of the leak. Upon reviewing the literature, we came across a few reports of reversible complications when using intrathecal fl uorescein [9][10][11] though most of the studies show that fl uorescein can be safely used [12][13][14]. No undesirable side-effect was detected in any of our patients after the use of intrathecal fl uorescein.…”

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

“…Lund also highlighted that adequate samples were attained in a small proportion of patients but, when received, produced positive results in most cases, reflecting its high sensitivity and specificity. 7,25 In our experience, CT scans with 1-mm slices employing BrainLab protocol was sufficient, as published management algorithms have indicated. 7,25 MRI has a complementary role particularly if there is clinical suspicion of meningoencephalocele (which are more common in the IIH and spontaneous leak demographic) or tumor.…”

“…7,25 In our experience, CT scans with 1-mm slices employing BrainLab protocol was sufficient, as published management algorithms have indicated. 7,25 MRI has a complementary role particularly if there is clinical suspicion of meningoencephalocele (which are more common in the IIH and spontaneous leak demographic) or tumor. 25 Although CT cisternography is advocated by some departments, we feel that its use does not add further information.…”

“…25 Nasal secretions sent for β2 transferrin yielded positive results in over 87%. Lund also highlighted that adequate samples were attained in a small proportion of patients but, when received, produced positive results in most cases, reflecting its high sensitivity and specificity.…”

“…7,25 MRI has a complementary role particularly if there is clinical suspicion of meningoencephalocele (which are more common in the IIH and spontaneous leak demographic) or tumor. 25 Although CT cisternography is advocated by some departments, we feel that its use does not add further information. 7,16 Our intraoperative use of intrathecal fluorescein was higher than some centres.…”