Cerebrospinal fluid rhinorrhea: Diagnostic role of gadolinium enhanced MR cisternography

Diagnosis of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

“…Although this study foregoes the noninvasive benefits of standard MRC, many feel it is a safe and effective alternative for identifying CSF fistulae. These studies report a sensitivity ranging from 61% to 100%, a specificity of 66% to 80%, a positive predictive value of 76%, and a negative predictive value of 93% . Four of these studies also evaluated the safety of this method by performing frequent neurologic checks on their patients following the procedure and at follow‐up visits over the next several months.…”

“…According to these studies, MRC is a legitimate option for CSF leak identification. One may use it in combination with other imaging techniques or choose to add intrathecal gadolinium, although these variables do affect the cost‐effectiveness and noninvasive nature of this method (Supporting material 8) Aggregate grade of evidence: C (Level 3: 21 studies); Benefit: Noninvasive (unless combined with intrathecal contrast) with good accuracy; Harm: None (unless combined with intrathecal contrast); Cost: $807.34; Benefits‐harm assessment: Preponderance of benefit over harm when diagnosis or site of leak is in doubt; Value judgments: Highly accurate test for the localization of CSF leak is important for operative planning; patients may prefer a test that does not involve radiation; nearly 3 times more expensive than HRCT; Recommendation level: Recommendation for cases where cheaper or less invasive studies have failed to diagnose or localize the site of a leak; Intervention: Using MRC for localizing CSF leaks. …”

Meningitis for Streptococcus salivarius secondary to paradoxical cerebrospinal fluid rhinorrhea as a complication of retrosigmoid approach

“…The presence of an abnormal communication leading to the apparition of rhinorrhea is potentially risk, since it can become a great chance for the development of an ascending infection, which can result in fulminant meningitis. [ 10 ] The CSF leak increases a 10% risk per year of developing meningitis. [ 11 ]…”

A modern approach to the diagnosis of nasal liquorrhea

“…Во многих исследованиях описана МРЦГ с контрастом (гадолинием), введенным эндолюмбально. Несмотря на то что это исследование инвазивное в отличие от стандартной МРЦГ, некоторые авторы [40,41] считают ее безопасной и эффективной альтернативой для установления локализации ликворной фистулы. По их данным, чувствительность МРЦГ с гадолинием находится в диапазоне 61-100%, специфичность -66-80%.…”

“…Возможно их сочетание с другими методами визуализации. Однако, учитывая высокую стоимость и инвазивность МРЦГ с введением гадолиния, они показаны лишь тогда, когда результаты других тестов неоднозначны [38,[40][41][42].…”