Summary
Exact preoperative localization of the dural defect is an essential requirement for successful surgery of CSF fistula. Eighteen digital subtraction cisternography (DSC) results reported here were performed upon 16 patients with CSF rhinorrhea and 1 patient with CSF otorrhea. The exact site of the dural lesion could be proved in 9 out of 11 cases with active CSF leakage. In 4 cases the fistula was located in the cribriform plate, whereas it was found in the planum sphenoidale and the middle cranial fossa in 2 and 3 cases respectively. The frontal basal cisterns could not be filled sufficiently with the contrast agent due to haematoma and a prefixed chiasm accompanied by arachnoid adhesions in two cases. DSC performed during the non-drip period (3 cases) and in patients suspected to have a CSF rhinorrhea (3 cases) did not reveal the site of leakage.
The investigation was followed by CT cisternography which allowed delineation of the lesion in the coronal view. In addition. MR with heavily T 2-weighted images (modification of the rapid acquisition with relaxation enhancement imaging) was performed upon 6 cases out of which the CSF fistula could be demarcated clearly in 4 patients, three with a traumatic CSF leakage and the other with an encephalomeningocele.
Surgery performed successfully in 9 cases confirmed the predicted site of dural dehiscence.
Being a dynamic investigation making the actual site of the CSF fistula visible, DSC is recommended in addition to CT cisternography which continues to be the most sensitive method for diagnosing dural and bony defects. It is suggested that heavily T 2-weighted MR images are useful in detecting the fistula in severe CSF rhinorrhea.
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Ahmadi I, Weiss MH, Segall HD, Schultz DH, Zee C-S, Giannotta SL (1985) Evaluation of cerebrospinal fluid rhinorrhea by metrizamide computed tomographic cisternography. Neurosurgery 16: 54–60
Bruton EM, Keith JW, Linden BE, Lazar RH (1990) CSF fistula in a patient with Mondini deformity: demonstration by CT cisternography. AJNR 11: 205–207
Curnes JT, Vincent LM, Kowalsky RJ, McCartney, WH, Staab EV (1985) CSF rhinorrhea: detection and localization using overpressure cisternography with Tc-99m-DTPA. Radiology 154: 795–799
Di Chiro G, Ommaya AK, Ashburn WL, Briner WH (1968) Isotope cisternography in the diagnosis and follow-up of cerebrospinal fluid rhinorrhea. J Neurosurg 28: 522–529
Di Chiro G, Girton ME, Frank JAet al (1986) Cerebrospinal fluid rhinorrhea: depiction with MR cisternography in dogs. Radiology 160: 221–222
Drayer BP, Wilkins RH, Boehnke M, Horton JA, Rosenbaum AE (1977) Cerebrospinal fluid rhinorrhea demonstrated by metrizamide CT cisternography. AJR 129: 149–151
Drayer BP, Rosenbaum AE (1978) Studies of the third circulation. Amipaque CT cisternography and ventriculography. J Neurosurg 48: 946–956
Gateholt H (1964) The reaction of glucose-oxidase test paper in normal nasal secretion. Acta Otolaryng 58: 271–272
Hennig J, Friedburg H, Stroebel B (1986) Rapid nontomographic approach to MR myelography without contrast agents. J Comput Assist Tomogr 10: 375–378
Lantz EJ, Forbes GS, Brown ML, Laws Jr ER (1980) Radiology of crebrospinal fluid rhinorrhea. AJR 135: 1023–1030
Loew F, Pertuiset B, Chaumier EE, Jaksche H (1984) Traumatic, spontaneous and postoperative CSF rhinorrhea. In: Symon Let al (eds) Advances and technical standards in neurosurgery, Vol 11. Springer, Wien New York, pp 169–207
Magnaes B, Solheim D (1977) Controlled overpressure cisternography to localize cerebrospinal fluid rhinorrhea. J Nucl Med 18: 109–111
Manelfe C, Cellerier P, Sobel D, Prevost C, Bonafe A (1982) Cerebrospinal fluid rhinorrhea: evaluation with metrizamide cisternography. AJR 138: 471–476
Naidich TP, Moran CJ (1980) Precise anatomic localization of atraumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography. J Neurosurg 53: 222–228
Oberascher G (1988) A modern concept of cerebrospinal fluid diagnosis in oto- and rhinorrhea. Rhinology 26: 89–103
Özgen T, Tekkök TH, Cila A, Erzen C (1990) CT cisternography in evaluation of cerebrospinal fluid rhinorrhea. Neuroradiology 32: 481–484
Takahashi T, Mutsuga N, Aoki Tet al (1988) Localization of dural fistulas using metrizamide digital subtraction fluoroscopic cisternography. J Neurosurg 68: 721–725
Yeates AE, Blumenkopf B, Drayer BP, Wilkins RH, Osborne D, Heinz ER (1984) Spontaneous CSF rhinorrhea arising from the middle cranial fossa: CT demonstration. AJNR 5: 820–821
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Wakhloo, A.K., van Velthoven, V., Schumacher, M. et al. Evaluation of MR imaging, digital subtraction cisternography, and CT cisternography in diagnosing CSF fistula. Acta neurochir 111, 119–127 (1991). https://doi.org/10.1007/BF01400499
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DOI: https://doi.org/10.1007/BF01400499