Evaluation of MR imaging, digital subtraction cisternography, and CT cisternography in diagnosing CSF fistula

Abstract

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 T2-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 T2-weighted MR images are useful in detecting the fistula in severe CSF rhinorrhea.

Neuroimaging in Superficial Siderosis: An In-Depth Look

“…62,63 Also reported is digital subtraction cisternography to identify intracranial CSF fistulas and digital substraction myelography to identify a dural tear in a patient with a cervical postoperative pseudomeningocele. [64][65][66] In an isolated report, digital substraction myelography has been used to identify the site of a leak in a patient with SS and a cervicothoracic epidural fluid collection (Fig 7C).…”

Localization of a Rapid CSF Leak with Digital Subtraction Myelography

“…Digital subtraction cisternography has been reported as a useful technique to identify intracranial CSF fistulas. [6][7][8] More recently, digital subtraction myelography was successfully used to localize the dural tear in the case of a high cervical postoperative pseudomeningocele. Fig 1. A, Sagittal T2-weighted (TR, 3300 msec; TE, 100.8 msec) image of the thoracic spine defines the caudal aspect of the epidural fluid collection at T6 -T7.…”

Avaliação da tomografia computadorizada e da cisternotomografia computadorizada com Lopamidol no topodiagnóstico da fístula liquórica e comparação com os achados cirúrgicos

“…[9][10][11][12] Dos métodos citados, apenas os últimos três têm colaborado no topodiagnóstico da FL. 5,9,10 Assim, apresentamos uma experiência de 46 casos de FL em que comparamos os resultados da tomografia simples, da cisternotomografia entre si, com os achados cirúrgicos.…”

“…Em 1991, Wakhloo et al 12 sugeriram o uso da Ressonância Magnética associado à cisternotomografia; é necessário evidenciar que a RM permite a individualização do cérebro dos tecidos adjacentes, permitindo a demonstração de herniação do parênquima cerebral para o espaço extradural. 9,10,26 Mais recentemente tem-se proposto o uso da RM cisternográfica, ponderada em T2, que dispensa o uso de contraste.…”