A COMPREHENSIVE DIAGNOSTIC ALGORITHM AND MANAGEMENT OF CEREBROSPINAL FLUID RHINORRHEA
1Başkent Üniversitesi Tıp Fakültesi, Radyoloji AD, Adana, Türkiye2Başkent Üniversitesi Tıp Fakültesi, KBB AD, Adana, Türkiye
3Başkent Üniversitesi Tıp Fakültesi, Beyin Cerrahisi AD, Adana, Türkiye Purpose: Patients with cerebrospinal fluid (CSF) leaks present a diagnostic challenge to both clinician and radiologist. We aimed to emphasize the indication for and importance of CT cisternography and compose a comprehensive diagnostic algorithm and management of cerebrospinal fluid rhinorrhea by reviewing the literature.
Materials and Methods: Thirty patients with clinically suspected CSF rhinorrhea were examined retrospectively for CSF fistula with CT cisternography. The CT cisternography study included 1mm thin coronal sections after injecting nonionic contrast material intrathecally via lumbar puncture. Bony and/or dural defects with entry of contrast into the ipsilateral paranasal sinuses were accepted as positive results.
Results: Thirty patients (17 females, 13 males) were included in this study. The cause of the leaks varied; twenty patients (%66.6) were due to trauma, one patient (%3.3) were iatrogenic, one patient (%3.3) were due to empty sella, one patient (%3.3) were congenital cephalocele, one patient traumatic cephalocele (%3.3) and 6 patients were idiopathic (%20). Among the 22 patients with bone defects, 13 (%43, 3) had CSF leak, and 9 (%30) patients had bone defects without had no CSF leak at CT cisternography. CT cisternography did not show bone defects or CSF leak for 8 patients (%26, 6). Nine patients whose CSF fistula had been shown on CT cisternography were operated and our findings were confirmed. Five patients (%16, 6) had craniotomy, 4 patients (%13, 3) had endoscopic surgery.
Conclusion: Precise preoperative localization is vital to effecting successful endoscopic surgery of CSF fistulas. To identify precise localization of defect provide available surgical planning and reduces recurrence. Practical diagnostic algorithm is necessary to avoid invasive methods at the beginning.
Keywords : Rhinorrhea, CT cisternography, Diagnosis algorithm