MRI FINDINGS IN SPONTANEOUS SPHENOID SINUS CEREBROSPINAL FLUID LEAKS
1Ankara Üniversitesi Tıp Fakültesi, Radyoloji Ana Bilim Dalı, Ankara, Türkiye2Ankara Üniversitesi Tıp Fakültesi, Kulak Burun ve Boğaz Hastalıkları Ana Bilim Dalı, Ankara, Türkiye Purpose:
To evaluate patients with sphenoid sinus cerebrospinal fluid (CSF) leakage in terms of accompanying MRI findings suggestive of idiopathic intracranial hypertension (IIH).
Methods:
This retrospective study included 14 patients diagnosed with sphenoid sinus CSF leakage between 2012 and 2023. MRI examinations were performed using 1.5T or 3T scanners with T2-weighted fat suppressed, T2-weighted SPACE, and CISS images. Images were evaluated for empty sella, arachnoid pits, fluid in the optic nerve sheaths, vertical tortuosity of the optic nerves, Meckel's caves enlargement, sphenoid sinüs lateral recess pneumatization, and encephaloceles. Lateral recess pneumatization was defined as pneumatization extending beyond the line connecting the foramen rotundum and Vidian canal. Descriptive statistics were applied.
Results:
The mean age of the patients was 56 ± 12 years (13 females, 1 male). Arachnoid pits were observed in all patients, while empty sella and Meckel's cave enlargement were present in 86% and 79%, respectively. Encephaloceles were identified in 71% of cases, and lateral pneumatization was present in 64%. In 36% of patients, CSF leakage occurred without excessive sphenoid sinus pneumatization. Four patients had additional CSF leaks at the cribriform plate. Of the 12 patients who underwent CT prior to MRI, 10 showed a bony defect at the site of the leak.
Conclusion:
Sphenoid sinus CSF leaks are frequently associated with MRI findings such as empty sella, arachnoid pits, and Meckel's cave enlargement, which likely reflect underlying intracranial hypertension. Recognition of these features on MRI is crucial for accurate diagnosis, localization of the defect, and optimal surgical planning.