Site Of Cerebrospinal Fluid Leak Research Articles

Evaluation of CSF Rhinorrhea by Computerized Tomography with Metrizamide

This study evaluates the ability of metrizamide computerized tomographic cisternography (MCTC) to delineate the site of leakage in patients with cerebrospinal fluid (CSF) rhinorrhea. From 1981 to 1986, thirteen patients were examined by MCTC to localize the site of CSF leakage. A total of 17 studies were performed. Thirteen scans (76%) identified the site of CSF leakage. Nine of these scans were confirmed surgically. The other four scans were performed on patients who refused surgery. Of the 15 scans in patients with active CSF leaks, 13 (87%) were positive. Of the two patients with inactive CSF leaks, neither was positive. One patient is presented in whom MCTC was both diagnostic and therapeutic. In conclusion, MCTC has a high success rate in localizing the site of active CSF leaks.

Cerebrospinal fluid rhinorrhea: evaluation with metrizamide cisternography

Metrizamide computed tomographic cisternography was used to examine 27 patients (19 males and eight females, 14-59 years old) clinically suspected of having cerebrospinal fluid fistulae with rhinorrhea. Twenty-one fistulae were traumatic and six were spontaneous. Five to 6 ml of metrizamide (or lopamidol, two cases) were injected by lumbar puncture at a concentration of 185-200 mg I/ml for direct coronal and axial computed tomographic sections of the skull base. Cerebrospinal fluid rhinorrhea was present at the time of examination in 12 of 27 cases. Results were evaluated according to three criteria: (1) metrizamide passage through the bony and dural defect; (2) demonstrable site of the fracture and/or bony defect; and (3) metrizamide visualized within a paranasal sinus, nasal cavity, or cotton pledget. The examination was considered positive when criterion 1 alone was present and when 2 and 3 were associated. In 15 of 27 cases, cisternography was positive, with the exact site of cerebrospinal fluid leakage demonstrated in 10 patients. In six cases, the results were not definitive; only one of the criteria (2 or 3) was fulfilled. In six cases, cisternography was normal. Seventeen patients underwent surgery. The site of cerebrospinal fistulae was ethmoidal in nine cases, frontoethmoidal in seven, sphenoidal in two, and sphenoethmoidal in one. The relative value of metrizamide computed tomographic cisternography compared with other diagnostic studies, polytomography, positive or negative contrast studies, and radionuclides, is discussed. Diagnostic pitfalls include artifacts and partial volume effect.

Cerebrospinal fluid rhinorrhea.

CEREBROSPINAL fluid (CSF) rhinorrhea is sometimes difficult to diagnose and treat. Trauma is the most common cause, and nontraumatic cases (spontaneous) are considered rare. Intracranial tumors have been regarded 1 as a common cause for nontraumatic rhinorrhea and the cribriform plate area in the anterior fossa as the most likely site of CSF leakage. The present paper reviews 35 cases of rhinorrhea treated at the Columbia-Presbyterian Medical Center during the past 36 years. This series is unique because of the large number of cases of rhinorrhea unassociated with trauma or tumor (11). The importance of spontaneous leakage through the middle fossa and sphenoid sinus is discussed. Method The records of the Columbia-Presbyterian Medical Center were used to locate all patients with CSF rhinorrhea between 1932 and 1968. Thirty-five records were obtained. Results Trauma.— Nine cases were associated with a definite history of trauma (Table 1). In four the rhinorrhea