Traumatic Cerebrospinal Fluid Leak Research Articles

To Evaluate the Frequencies of Post- Traumatic Cerebrospinal Fluid Leak in Patients Presenting with Traumatic Brain Injury

Introduction: Traumatic brain injury is the fourth largest cause of fatal trauma worldwide. The social and economic implications of traumatic brain injuries are immense whilst the physical and mental bearing upon the patient is devastating. Objective: Objective of this study is to evaluate the frequencies of post- traumatic cerebrospinal fluid leak in patients presenting with traumatic brain injury. Methodology of the study: This study was conducted at Neuro Surgery Department of Lady Reading Hospital, Peshawar during 20/7/2020 to 20/1/2021.In the current study a total of 303 patients presenting with initial head trauma presenting within 24 hours with Glasgow coma score ≤15, patients in age between 18 to 65 years and both gender (male/female) were included in the study. All the patients were subjected for detailed history, clinical examination and radiological examination i.e. CT and MRI was done for the confirmation of brain injury. All the patients were followed till 7th post operative day for the diagnosis of Cerebrospinal fluid leak. It is clear water cerebrospinal fluid discharge diagnosed on clinical examination till 7th post-trauma day and was determined in terms of rhinorrhea or otorrhea. Results: Our study shows that among 303 patients was analyzed as 215(71%) patients were in age range 18-40 years, 88(29%) patients were in age range 41-65 years. 239(79%) patients were male and 64(21%) patients were female. More over 18(6%) patients had CSF leak while 285(94%) patients didn’t had CSF leak. Practical Implication: This study will be useful for finding the post-traumatic cerebrospinal fluid leak. Conclusion: Our study concludes that the frequencies of post-traumatic cerebrospinal fluid leak was 6% in patients presenting with traumatic brain injury. Keywords: Post-traumatic cerebrospinal fluid leak, traumatic brain injury.

Epidemiology of Anterior and Lateral Basilar Skull Fractures With CSF Leak: A National Trauma Data Bank Analysis.

Cerebrospinal fluid (CSF) leaks are a complication from dural violations that can occur in the setting of skull base fractures. No prior study provides a nationwide epidemiological analysis of traumatic CSF leaks. The objective of this report is to characterize patient demographics, injury-related variables, and operative management. The national trauma data bank was queried for both anterior and lateral skull base fracture cases between 2008 and 2016. Clinical data were extracted. A total of 242 skull base fractures with CSF leak were identified. Most patients were male (84.3%), and the median patient age was 39.7±17.6 years old. Glasgow Coma Scale was 14.0 [interquartile range (IQR): 6.5-10.6] for lateral fractures, 13.0 (IQR: 3.0-10.0) for anterior fractures, and severe range for combined fractures at 7.0 (IQR: 5.0-9.0) (analysis of variance, P =0.122). Common mechanisms of injury were motor vehicle accidents (107, 44.2%), followed by falls and firearms (65, 26.9% and 20, 8.3%, respectively). The median length of stay was 2 weeks, with a median of 14 days (IQR: 10-25) for the anterior fractures and 10 days (IQR 5-19) among the lateral fractures ( P =0.592). Patients were most commonly discharged home in both the anterior (43.8%) and lateral (49.2%) groups. The prototypical patient tends to be a young adult male presenting with moderate-to-severe range neurological dysfunction after a vehicular accident. The overall prognosis of skull base fractures with CSF leak remains encouraging, with nearly half of these patients being discharged home within 2 weeks.

Usefulness of Intrathecal Low-dose Fluorescein Administration for the Treatment of Recurrent Traumatic Cerebrospinal Fluid Leak

Usefulness of Intrathecal Low-dose Fluorescein Administration for the Treatment of Recurrent Traumatic Cerebrospinal Fluid Leak

A Makeshift Blue Light Filter for Endoscopic Identification of Traumatic Cerebrospinal Fluid Leak Using Fluorescein


 
 
 
 ABSTRACTObjective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient.
 
 
 
 
 Methods:Study Design:Surgical Instrumentation
 Setting:Tertiary Government Training Hospital
 Patient:One
 
 
 
 
 Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted.
 
 
 
 
 Conclusion: Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Expansion of the Foramen Ovale in Patients With Cerebrospinal Fluid Leak or Encephalocele.

Spontaneous cerebrospinal fluid (CSF) leaks are associated with elevated intracranial pressure and idiopathic intracranial hypertension (IIH). Skull base erosion and widening of the foramen ovale have been reported in patients with IIH. This study sought to investigate changes in the size of the foramen ovale and foramen spinosum in patients with IIH, spontaneous CSF leak, and encephalocele. Retrospective cohort study. Tertiary care academic medical center. Adult patients treated from 2014 to 2018 with computed tomographic imaging of the head and who were diagnosed with IIH, encephalocele, or CSF leak. Two blinded observers measured the long and short axes of the foramen ovale and foramen spinosum on axial computed tomographic images. Measurements were used to calculate the approximate elliptical cross-sectional area of the foramina. Length, width, and area of the foramen ovale and foramen spinosum. A total of 264 patients were identified meeting the inclusion criteria and were placed into three groups. There were 170 patients with IIH, 48 with spontaneous CSF leak or encephalocele (CSF/E group), and 46 with traumatic or iatrogenic CSF leak (control group). Mean foramen ovale short axis (4.85 ± 1.00 mm) and cross-sectional area (30.17 ± 9.25 mm2) in the CSF/E group were significantly increased compared with measurements in patients with IIH or the control groups. Foramen ovale size was positively correlated with age in the CSF/E group. No significant difference in foramen spinosum size was found. Skull base defect resulting in spontaneous CSF leak or encephalocele is associated with enlargement of the foramen ovale on axial computed tomography.

Non Spontaneous Cerebrospinal Fluid Rhinorrhoea and Subsequent Bacterial Meningitis: A Case Report

Cerebrospinal Fluid (CSF) protects brain and maintains intracranial pressure which is secreted by choroid plexus. After severe Craniomaxillofacial (CMF) trauma, disruption of meningeal structure leads to CSF leak. About 80-90% of CSF leak in adults is due to head injuries. CSF rhinorrhoea can be classified into spontaneous and non spontaneous. Meningitis is seen in 19% of persistent CSF leakage with 10% of mortality due to delayed and longer duration of the CSF leakage. Post-traumatic CSF leaks are commonly seen in 1-3% of adults among all head injuries. Traumatic CSF leak is reported to be approximately 10-30% of the skull base fractures in adults. Common pathogens of meningitis are Haemophilus influenzae (H. influenzae) and Streptococcus pneumoniae (S. pneumoniae). Present case was of non spontaneous CSF rhinorrhoea and subsequent bacterial meningitis in a 33-year-old male patient, with fever and chills, headache, vomiting, neck stiffness. Kernig sign’s was present. Patient had past history of road traffic accident and found to have CMF injury. Neurosurgery opinion was sought and found to be persistent CSF rhinorrhoea. Haematological and chemical analysis of cerebrospinal fluid was abnormal. CSF and blood sample sent for culture and sensitivity. H. influenzae grown in both culture. H. influenzae is an uncommon cause of adult bacterial meningitis.

The Endonasal Endoscopic Management of Cerebrospinal Fluid Rhinorrhea.

IntroductionCerebrospinal fluid (CSF) rhinorrhea is the result of a bony defect at the skull base with disruption of the arachnoid, dura mater, and sinonasal mucosa that leads to an active CSF leak and flow of clear fluid from the nose. The endoscopic repair of CSF leaks and skull defects have been used by an increasing number of surgeons and is the standard of care for repairing CSF leaks.Materials and methodsWe conducted a retrospective study of all cases of CSF leaks managed via the endonasal endoscopic approach from 2010 to 2020 at a tertiary referral hospital of King Fahad Specialist Hospital, Dammam (KFSH-D).ResultsOver 10 years, 61 procedures were performed on a total of 56 patients (average age, 39.9 years) with 26 spontaneous CSF leaks and 30 traumatic CSF leaks. The leak sites were frontal bone in 14% of the cases, the roof of the ethmoid in 25%, the cribriform plate of ethmoid in 39%, and the walls of sphenoid sinus in 21%; multiple site defects were found in eight patients. The defect was localized by high-resolution computed tomography (CT) of the paranasal sinuses and skull base and magnetic resonance imaging (MRI) in all patients. CT cisternography, intrathecal fluorescein injection, and topical application of fluorescein dye were used in patients as required. A combination of free grafts and flaps materials were used in most patients. A middle and inferior turbinate graft was used in 12 patients, a septal cartilage graft in 18 patients, and a pedicled nasoseptal flap in 12 patients. The success rate was 92% after the first closure attempt. A recurrence of CSF leaks was observed in four patients. The mean hospitalization time was 6.5 days. The postoperative follow-up period ranged from one year to 10 years with a mean postoperative follow-up time of three years.ConclusionsThe endonasal endoscopic approach is the current standard of care for repairing most CSF leaks and skull base defects. We have had an excellent experience with endonasal endoscopic CSF leak repair, with high success rates and low morbidity. Our results support the effectiveness and safety of this technique and should encourage otolaryngologists to apply the procedure in cases of CSF leak.

Bordetella bronchiseptica: a rare cause of meningitis

BackgroundBordetella bronchiseptica is a gram-negative, obligate aerobic coccobacillus known to cause disease in domesticated animals and pets. In humans, B. bronchiseptica commonly leads to respiratory infections like pneumonia or bronchitis, and animal contact usually precedes the onset of symptoms.Case presentationWe report a case of post-traumatic B. bronchiseptica meningitis without recent surgery in the setting of immunosuppression with a monoclonal antibody. Our case concerns a 77-year-old male with ulcerative colitis on infliximab who sustained a mechanical fall and developed a traumatic cerebrospinal fluid leak complicated by meningitis. He received meropenem then ceftazidime during his hospital course, and temporary neurosurgical drain placement was required. His clinical condition improved, and he was discharged at his baseline neurological status.ConclusionsB. bronchiseptica is an unusual cause of meningitis that may warrant consideration in immunocompromised hosts with known or suspected animal exposures. To better characterize this rare cause of meningitis, we performed a systematic literature review and summarized all previously reported cases.

Role of Continuous Lumbar Drainage in Cerebrospinal Fluid Leak: A Prospective Study

Abstract Background: Cerebrospinal Fluid (CSF) leak is one of the most disturbing issues that face neurosurgeons. Aim of Study: The aim of this study is to illustrate the efficacy of Continuous Lumbar Drainage (CLD) as a prophy-lactic and therapeutic method for CSF leak with assessment of clinical outcome and early post-operative sequelae. Patients and Methods: This study was prospectively conducted on patients with traumatic or post-operative CSF leak and those susceptible for post-operative CSF leak as skull base and spinal intradural surgeries in the period from May 2015 to November 2015 at the Neurosurgery Departments of Cairo and Fayoum Universities. These patients were sub-jected to insertion of CLD. Results: Excellent results in 15 patients who showed cessation of CSF leak within 4 days of CLD, good results in 4 patients who showed cessation of CSF leak within 5 days of CLD and fair results only with one patient required re-exploration then showed cessation of CSF leak within 5 days of CLD. Conclusion: The present analysis of the data reveals that CLD is used as a prophylactic measure and a line of treatment for CSF leak. It may be used pre, intra or post-operatively. This study recommends the use of CLD in cases with CSF leak or suspected post-operative CSF leak.

Continuous Lumbar Drainage for the Prevention and Management of Perioperative Cerebrospinal Fluid Leakage.

Background:Cerebrospinal fluid (CSF) leak is an unfortunate, yet well-recognized complication of skull base fractures, skull base surgeries, and variety of spinal procedures. Continuous lumbar drainage (CLD) of leaking CSF has shown a high success rate with minimal morbidities in handling CSF leak in these patients. Therefore, we conducted this study to illustrate the efficacy of CLD as a prophylactic and therapeutic method for CSF leakage with the assessment of clinical outcome and early postoperative sequel.Materials and Methods:In the period from January to December 2017, patients with traumatic or postoperative CSF leak and those susceptible for postoperative CSF leak as skull base and spinal intradural surgeries at the Neurosurgery Department, Fayoum University, were included in our study.Results:A total of 20 eligible patients were included in the study. All patients showed successful cessation of CSF leakage at different durations of CLD. Fifteen patients showed excellent results; four showed good results; and one showed fair results. Besides a minimal pneumocephalus, headache was the most common presenting complication in our population, which occurred to all patients. Six patients had vomiting beside headache, whereas two patients experienced vomiting and nausea in addition to headache. There were neither mortalities nor life-threatening complications noted; however, a superficial wound infection occurred in a single case.Conclusion:CLD is a simple, safe, and efficient method in the management of CSF leakage at operative sites, CSF rhinorrhea, and CSF otorrhea of various etiologies.

Traumatic cerebrospinal fluid leakage following septorhinoplasty.

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks.

The objective of this review is to provide an overview on the diagnosis and management of traumatic cerebrospinal fluid (CSF) leaks. This comprehensive review explores controversies associated with the management of CSF leaks as well as a review of the most contemporary literature. The scope of this article covers both traumatic CSF leaks of the middle and anterior cranial fossae.

A Stratified Algorithm for Skull Base Reconstruction With Endoscopic Endonasal Approach.

The authors presented our institutional experience with skull base reconstruction techniques and developed a stratified algorithm for different causes of cerebrospinal fluid (CSF) leak. This is a retrospective review of patients who were diagnosed as CSF leak treated with skull base reconstruction or who underwent endoscopic transsphenoidal surgery for sellar and parasellar lesions at our department from August 2012 to April 2017. The authors totally identified 57 (59 operations in total) patients who were divided into 3 groups according to the causes of CSF leak and different reconstruction techniques. All patients underwent skull base reconstruction with specific focus on diagnosis, reconstruction techniques and strategies, and clinical outcome. The reconstruction technique we adopted was the classical multiple-layer technique, as known as "sandwich" technique, with combination of fat tissue, septal bone, autologous fascia lata, artificial dura, and nasoseptal flap (NSF). The NSF was selectively harvested for large defects according to our protocol. The reconstruction failure rate is 4.4% (2 of 45) in patients underwent endoscopic surgery for sellar and parasellar lesions. Reconstruction for postoperative iatrogenic, traumatic, and spontaneous CSF leak achieved 100% success rate; 54.2% (32 of 59) operations were done with "sandwich" plus NSF. The overall failure rate of all reconstructions was 3.4% (2 of 59). A stratified approach with multiple-layer technique and NSF is reliable for skull base reconstruction.

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Abstract A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

Endoscopic Removal of a Bullet in Rosenmuller Fossa: Case Report

Fractures of the anterior skull base may occur in gunshot victims and can result in traumatic cerebrospinal fluid (CSF) leak. Less commonly, CSF leaks occur days or even weeks after the trauma occurred. Here, we present the case of a 21-year-old man with a delayed-onset, traumatic CSF leak secondary to a missile injury that left a bullet fragment in the Rosenmuller fossa. The patient was treated successfully with endoscopic, endonasal extraction of the bullet, and repair with a nasal septal flap. Foreign bodies lodged in Rosenmuller fossa can be successfully treated with endoscopic skull base surgery.

Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults.

The goals of this study are to: 1) investigate the urgency for repair of middle cranial fossa spontaneous cerebrospinal fluid (CSF) leaks in adults, and 2) review the literature and treatment recommendations for adult spontaneous CSF otorrhea. 1) All patients who were referred to a tertiary center with spontaneous CSF otorrhea, exposed middle cranial fossa dura, or encephalocele from 2004 to 2015; and 2) landmark references on spontaneous CSF leaks Electronic medical records of patients with a documented spontaneous CSF leak, exposed dura, or encephalocele were reviewed. Subjects were excluded if they had a congenital, traumatic, or iatrogenic CSF leak. Main outcome measure was duration of CSF leak and development of meningitis after clinical presentation. Twenty-two patients (27 ears) who were at risk for meningitis from spontaneous CSF otorrhea, encephalocele, or a dural breach with or without mastoiditis were evaluated. Duration of CSF leaks in patients who refused repair or who continued to have CSF leak after repair or prior to successful repair ranged from 4 months to 11 years. Duration of encephaloceles and dural exposure in an uninfected mastoid ranged from 24 months to 6 years. Only one patient presented with meningitis. None of these 22 patients developed meningitis during the time periods they were under our care. Should patients with CSF otorrhea, exposed dura, or encephalocele refuse operation, it may be reasonable to follow them with close observation and education about warning signs for meningitis.

Patterns and sequelae of sphenoid sinus fractures.

The sphenoid sinus is one of the most commonly fractured regions of the skull base after blunt head trauma. These fractures may be associated with complications such as blunt carotid artery injury (BCAI) and cerebrospinal fluid (CSF) leak. Association of these sequelae with sphenoid sinus fractures has yet to be analyzed thoroughly in the literature. Analyze patterns of traumatic sphenoid sinus fractures and assess relationships between fracture patterns and incidence of BCAI and traumatic nasal CSF leaks. A retrospective review of 123 patients sustaining sphenoid sinus fractures was performed. Patient medical records and radiographic images were reviewed. Fractures were classified based on the sinus walls involved. Logistic and linear regressions were used to analyze associations between injury mechanisms, fracture subsites, and sequelae. The most commonly fractured sphenoid sinus subsites included the carotid canal, sphenoid roof, and lateral wall (60%, 49% and 48%, respectively). CSF leaks occurred in 9% of sphenoid sinus fractures, whereas BCAI occurred in 1.6%. On logistic regression, sphenoid roof fractures were significantly associated with CSF leaks (odds ratio [OR] = 12.4, p = 0.002). No fracture subsite was associated with BCAI. The positive predictive value (PPV) of sphenoid roof fractures for the presence of CSF leaks was 17%, whereas the negative predictive value (NPV) was 98%. The PPV of carotid canal fractures for BCAI was 3%, whereas the NPV was 100%. There was no association between the number of fractured sinus walls and the incidence of BCAI or CSF leak. Penetrating injuries were significantly associated with CSF leak (OR = 24.7, p = 0.01), but no other injury mechanisms were associated with BCAI or CSF leak. Nasal CSF leak was the most common sequela of sphenoid sinus fractures, whereas BCAI was extremely uncommon. Analysis of fracture patterns can be useful in determining the need for additional evaluation.

Treatment of cerebrospinal fluid rhinorrhea.

Cerebrospinal fluid (CSF) rhinorrhea is a rare entity that can arise from a variety of causes. Successful management has been reported using a variety of repair techniques. The goal of this study is to make recommendations on intraoperative and postoperative management of CSF fistulas across all causes. Pooled analysis of case series reveals that free graft repairs are successful in closing most traumatic and iatrogenic CSF leaks. In contrast, multilayered, vascularized repairs are often required for large defects with high-flow leaks that communicate with a cistern and/or ventricles. Spontaneous CSF leaks are associated with idiopathic intracranial hypertension in the vast majority of cases, and when present, postoperative medical management is necessary for long-term success. Patients with CSF rhinorrhea require surgical repair to prevent life-threatening complications. Many techniques and materials are effective at achieving closure of CSF fistula across causes. Evidence suggests that patients with high-flow CSF fistulas have improved outcomes with multilayered, vascularized repairs to decrease the risk of postoperative CSF leaks. Patients with idiopathic intracranial hypertension need long-term management of the underlying disease process.

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

Objective To describe our experience of cerebrospinal fluid (CSF) rhinorrhea management. Design Retrospective. Setting Charing Cross Hospital, London, a tertiary referral center. Participants Fifty-four patients with CSF rhinorrhea managed from 2003 to 2011. Main outcome measures Surgical technique; Recurrence. Results Etiologically, 36 were spontaneous and 18 traumatic. Eight patients with spontaneous and two with traumatic leaks had previous failed repairs in other units. Success rates after first and second surgery were 93% and 100%, respectively. Mean follow-up was 21 months. Four patients, all of spontaneous etiology, had recurrences; three of these underwent successful second repair with three layered technique, and the fourth had complete cessation of the leak after gastric bypass surgery and subsequent weight reduction. Adaptation of anatomic three-layered repair since then averted any further failure in the following 7 years. Mean body mass index was 34.0 kg/m(2) in spontaneous and 27.8 kg/m(2) in traumatic cases (p < 0.05). Fifty percent of spontaneous leaks were from the cribriform plate, 22% sphenoid, 14% ethmoid, and 14% frontal sinus. In the traumatic CSF leak group: 33.3% were from the cribriform plate, 33.3% sphenoid, 22.2% ethmoid, and 11.1% frontal. Conclusion Endoscopic CSF fistula closure is a safe and effective operation. All sites of leak can be accessed endoscopically. We recommend the use of an anatomic three-layered closure in difficult cases.

Comparison Between Computed Tomography-Myelography and Radioisotope-Cisternography Findings in Whiplash-Associated Disorders Suspected to Be Caused by Traumatic Cerebrospinal Fluid Leak

A retrospective observational study. To investigate the traumatic cerebrospinal fluid (CSF) leak in whiplash-associated disorders (WADs) by comparing radioisotope-cisternography (RIC) and computed tomography (CT)-myelography (CTM) findings. WAD has been considered to be caused by traumatic CSF leak and termed as traumatic CSF hypovolemia. Several studies have reported that CSF leak was detected on RIC in the lumbosacral region of patients with WAD. However, recent evidence has indicated that RIC sometimes creates false-positive results by detecting nerve roots or cysts as CSF leak, whereas the appearance of contrast medium in the epidural space on CTM demonstrates CSF leak directly. So far there have been no data to compare the RIC and CTM findings in patients with WAD. RIC and CTM were performed on 36 patients with WAD, and the RIC and CTM findings were compared. In RIC, 37 MBq (111)In was injected, and paraspinal RI accumulation was evaluated as a direct sign of CSF leak. In CTM, 10 mL of iohexiol (240 mg I/mL) was infused via lumbar puncture, and multislice CT scan of the whole spine was acquired. Epidural collection of contrast medium, nerve root morphology, and cystic structures were investigated. Paraspinal RI accumulation was observed in 19 patients on RIC, and it was located in the lumbosacral region in 18 patients. In contrast, no epidural collection was observed on CTM. CTM findings revealed that root sleeves and cystic structures were observed at the locations in which paraspinal RI accumulation was noted on RIC. The results in this study indicated that traumatic CSF leak was not observed on CTM in patients with WAD, in whom CSF leak was suspected on RIC.