No leak could be demonstrated in the other 17. 4 were after traumatism and 2 after removal of a tumor, in fronto-ethmoido-sphenoidal base of the skull. Motor vehicle accidents cause 20 to 50% of fatal head injuries. 2015 Jul 29;6:126. doi: 10.4103/2152-7806.161787. Obliteration and cranialization seem to decrease in numbers. 34, No.  |  After pluridirectional tomography demonstrated a bone defect in the clivus, the diagnosis was established by means of computerized tomography (CT) by comparing the absorption coefficients of a soft-tissue mass within the sphenoid sinus before and after the. We conclude that radionuclide infusion cisternography is a safe, rapid, and accurate method of investigating a suspected or proven CSF rhinorrhea and that it is complementary to metrizamide cisternography. frontal bone lesion. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. COVID-19 is an emerging, rapidly evolving situation. Clipboard, Search History, and several other advanced features are temporarily unavailable. 4, 17 September 2009 | American Journal of Neuroradiology, Vol. Cerebrospinal fluid (CSF) fistulae result from defects in the pia-arachnoid membrane and dura such that the CSF can escape its normal reservoirs and pathways. 1, European Journal of Nuclear Medicine, Vol. We performed 32 overpressure radionuclide cisternography (ORNC) studies to examine 26 patients who were clinically suspected of having cerebrospinal fluid (CSF) fistula with rhinorrhea. 222, No. As in the case of radionuclide studies in the evaluation of disorders of the brain, the introduction of computed tomography has resulted in a major reduction in the use of radionuclide cisternography. Of 23 examinations performed in patients who had clinically documented CSF rhinorrhea, 15 (65%) were scintigraphically positive. No leak could be demonstrated in the other 17. rhinorrhea. Initially described by Galen in 200 B.C. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. We suspected cerebrospinal fluid rhinorrhea. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. CSF leaks: Correlation of High-Resolution CT and Multiplanar reformations with Intraoperative Endoscopic findings. In this case debridement of the frontal bone was not necessary. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Careful evaluation of the brain CT and MRI revealed a right frontal sinus posterior wall defect and possible brain encephalocele. Both procedures are characterized by weak local resolution [187]. Brain CT was interpreted as right frontal sinus opacification suggestive of sinusitis. A bifrontal craniotomy was performed, the encephalocele was resected and cranialisation of the frontal sinus was completed. This site needs JavaScript to work properly. Minimal invasive surgical intervention was performed together with a strict regimen of antibiotic therapy. The patient remained free of seizures at the last follow-up. Minimally invasive and having lower post op morbidity, compared to traditional intracranial techniques, repairing CSF leak endoscopically has evolved to become the standard, An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull. hyperpressure. 1, 1 September 2008 | Radiology, Vol. [Diagnosis of cerebrospinal fluid leakages by gamma-cisternography]. Clin Nucl Med. Access scientific knowledge from anywhere. This method has been used in conjunction with clinical examination and other neurological procedures in children to aid in the evaluation of hydrocephalus. No leak could be demonstrated in the other 17. Radionuclide cisternography permits the observation of the mixing and absorption of the cerebrospinal fluid (CSF). 6, Otolaryngologic Clinics of North America, Vol. Of 23 examinations performed in patients who had clinically documented CSF rhinorrhea, 15 (65%) were scintigraphically positive. USA.gov. 44, No. Nuklearmedizinische Untersuchungen in der Kinderradiologie, The Surgical Treatment of Facial Injuries, Cerebrospinal fluid rhinorrhea studied with the gamma scintillation camera, Spontaneous “High-Pressure Cerebrospinal Rhinorrhea” Due to Lesions Obstructing Flow of Cerebrospinal Fluid, Prolactinomas and nonfunctioning adenomas: preoperative diagnosis of tumor type using serum prolactin and tumor size, Outcomes After Repeat Transsphenoidal Surgery for Recurrent Cushing Disease: Updated, [Repair of recurrent osteo-meningeal lesions at the base of the skull], Endonasal endoscopic repair of ethmoid roof cerebral fluid fistula by suturing the dura, An 8-year-old boy with a Pott's puffy tumor. During this to-and-fro movement, mixing would occur and the kinetics of distribution of the tracer would be of the diffusional type and with a very high coefficient of diffusion.12,41. Canadian Association of Radiologists Journal, Vol. as a normal, periodic release of CSF into the nose through the sella and ethmoids, CSF rhinorrhea was considered physiological until Thompson described it as a pathologic entity in 1899.2, 4, 5 The most widely accepted classification system, proposed by Ommaya 6 in 1960s primarily divides CSF rhinorrhea into traumatic and nontraumatic categories, … The slightly fewer patients with a traumatic cause compared with those reported in most series reflects the referral patterns and surgical nature of the practice at the institution. We performed 32 overpressure radionuclide cisternography (ORNC) studies to examine 26 patients who were clinically suspected of having cerebrospinal fluid (CSF) fistula with rhinorrhea. 6-8, © 2020 Radiological Society of North America, https://doi.org/10.1148/radiology.154.3.3881800, T2-weighted vs. intrathecal contrast-enhanced MR cisternography in the evaluation of CSF rhinorrhea, Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage, Prise en charge radiologique des brèches ostéo-durales : à propos d’un cas rare de brèche ethmoïdale de nature spontanée, Tc-99m DTPA Cisternography Shows Disappearance of Cerebrospinal Fluid Leakage After Standing a Short Time, Imaging of Skull Base Cerebrospinal Fluid Leaks in Adults1, Intrathecal Administration of Gadopentetate Dimeglumine for MR Cisternography of Nasoethmoidal CSF Fistula, Migration of Tc-99m DTPA from the Cerebral Ventricle to the Subarachnoid Space, Intrathecal Gadolinium-enhanced MR Cisternography in the Evaluation of Clinically Suspected Cerebrospinal Fluid Rhinorrhea in Humans: Early Experience1, Evaluation of intrathecal gadolinium-enhanced MR cisternography in a rabbit model of traumatic nasoethmoidal CSF fistula, Craneotomía bifrontal y colgajo pediculado de pericráneo en el tratamiento de las fístulas traumáticas de LCR, Overpressure radionuclide cisternography and metrizamide computed tomographic cisternography in the detection of intermittent rhinoliquorrheas in children. Fifty-one patients with cerebrospinal fluid rhinorrhea were evaluated at the Mayo Clinic from 1974 to 1977. 37, No. Imaging findings were compared with endoscopic findings, being the gold standard for the assessment of CSF rhinorrhea.A total of 25 patients had a combination of HRCT and MR cisternography.  |  injection of metrizamide into the lumbar subarachnoid space. AJNR Am J Neuroradiol. 2, 30 April 2013 | Acta Radiologica, Vol. AJR Am J Roentgenol. Three-fourths of the patients had plain films of the skull, although the site of the leak was identified in only 21% of them. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.  |  Patient discomfort and side effects were minimal. The authors suggest to combine bone reconstruction by autograft to the dural repair, even in case of primary fistula, when there is a severe traumatic or tumoral bone defect, or when we are dealing with a spontaneous rhinorrhea which is known to be generally due to local C.S.F. Get the latest public health information from CDC: https://www.coronavirus.gov. doi: 10.1097/00003072-198110001-00016. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. We conclude that radionuclide infusion cisternography is a safe, rapid, and accurate method of investigating a suspected or proven CSF rhinorrhea and that it is complementary to metrizamide cisternography. 248, No. Fifteen (47%) of these cisternography studies were positive, and the site of the leak was identified. Widespread use of endoscope in sinus surgery have made us more familiar with the anatomy of the sinuses as well as the skull base. The patient had complained of chronic nasal discharge for years and had also noticed a watery discharge from her right nostril. HHS As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. 27, No. Enter your email address below and we will send you the reset instructions. practice for management of CSF leak. AJNR 2008;29:536-41. C1-C2 cryptic cerebrospinal fluid leak directly identified by pressurized radionuclide cisternography: Case report and review of the literature. Surg Neurol Int. Guo H, Kommidi H, Maachani UB, Voronina JC, Zhang W, Magge RS, Ivanidze J, Wu AP, Souweidane MM, Aras O, Ting R. Mol Pharm. Background: Cerebrospinal fluid (CSF) rhinorrhea, when left untreated, can lead to meningitis and other serious complications. Spontaneous CSF leakage is rare, because most of the patients have some history of trauma, surgery, or a tumor that presented years before, but is often misdiagnosed. J Neurol Neursurg The central nervous system (CNS) is normally protected from pathogenic organisms by mechanical barriers and the host’s natural defense system. Radiology of Cerebrospinal fluid rhinorrhea. Trauma is the most common cause of death and permanent disability in the early decades of life, with neurologic trauma causing the majority of these injuries. Childs Nerv Syst. Discussion These fistulae may be manifested as a leakage from a lumbar puncture, a scalp defect, or drainage of CSF from the nose (rhinorrhea) or ear (otorrhea). 1999 Apr;20(4):706-12. © 2008-2020 ResearchGate GmbH. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. 11, No. 31, No. 1, Clinical Nuclear Medicine, Vol. 12, 1 February 2002 | Radiology, Vol. MRI with intrathecal Gadolinium to Detect a CSF leak: a prospective open-labe cohort study. These fistulae may be manifested as a leakage from a lumbar puncture, a scalp defect, or drainage of CSF from the nose (rhinorrhea) or ear (otorrhea). Endonasal endoscopic closure of cerebrospinal fluid rhinorrhea. LaFata V, et al. The patient was discharged home with an amoxicillin prescription. 1977 Jul;129(1):149-51. doi: 10.2214/ajr.129.1.149. The rapid cephalad transit of the radionuclide bolus allowed completion of the study within 30 to 45 minutes. It has been shown that with each pulse, about 0.75 ml of fluid from the cranium moves down into the spinal canal during systole and returns to the head in diastole. Two-thirds of the patients had tomography, which was helpful in 53%, especially in 10 of the 13 patients with traumatic nonpostoperative cerebrospinal fluid rhinorrhea. Stone JA, Castillo M, Neelon B, Mukherji SK. Fatal head injury occurs four times more frequently in males.1. Over the past 20years, improvement in surgical techniques as well advances in surgical instruments for sinus surgery has led to surgical closure of cerebrospinal fluid (CSF) leak using endoscopic approach. order to repair the osteo-dural lesions with autogenous aponeurosis and bone grafts. Early diagnosis using thorough radiological evaluation is necessary to effectuate the proper therapeutic approach.