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

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 administrati...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2010-01, Vol.31 (1), p.71-75
Main Authors: Selcuk, H, Albayram, S, Ozer, H, Ulus, S, Sanus, G.Z, Kaynar, M.Y, Kocer, N, Islak, C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Brain
Cerebrospinal Fluid Otorrhea - diagnosis
Cerebrospinal Fluid Rhinorrhea - diagnosis
Contrast Media
Electrodiagnosis. Electric activity recording
Female
Gadolinium
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Myelography - methods
Nervous system
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Young Adult
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Summary: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. 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. 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 >1 paranasal sinus. 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.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A1788