Evaluation of Cerebrospinal Fluid Rhinorrhea by Metrizamide Computed Tomographic Cisternography

Abstract Seven interesting and instructive cases of cerebrospinal fluid rhinorrhea evaluated by metrizamide computed tomographic cisternography are presented. The rhinorrhea was spontaneous in three patients and was related to previous head trauma or surgical procedures in four patients. The anatomical site and the extent of the fistula were demonstrated precisely by directly showing metrizamide passing through the bony defect. A combination of bone dehiscence and metrizamide within the adjacent paranasal sinuses or the nasal cavity is also useful in localization. Distortion of the interhemispheric fissure, sylvian fissure, or basal sulci indicates the probability of brain herniation through the defect. (Neurosurgery 16:54–60, 1985)

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Cerebrospinal Fluid Rhinorrhea as the First Symptom of Metastatic Prostate Adenocarcinoma

Ear Nose & Throat Journal ◽

10.1177/01455613211016710 ◽

2021 ◽

pp. 014556132110167

Author(s):

Magdalena Ostrowska ◽

Maciej J. Wróbel

Keyword(s):

Prostate Cancer ◽

Cerebrospinal Fluid ◽

Paranasal Sinuses ◽

Cancer Metastasis ◽

Treatment Strategies ◽

Prostate Adenocarcinoma ◽

Cerebrospinal Fluid Rhinorrhea ◽

Csf Leakage ◽

Prostate Cancer Metastasis ◽

Csf Rhinorrhoea

The most common cause of cerebrospinal fluid (CSF) rhinorrhoea is damage to the skull base with a dura mater’s rupture due to an accident or an iatrogenic injury. This applies to over 96% of cases. Other possibilities that can lead to CSF leakage are neoplasms of the nasal cavity, paranasal sinuses, and nasopharynx. Although prostate cancer spreads to bones, cranial metastases to paranasal sinuses are extremely rare. We present a case of an 83-year-old patient with CSF leakage due to infiltrating metastatic prostate cancer. Cerebrospinal fluid rhinorrhea turned out to be the first symptom of prostate cancer metastasis. Diagnostic and treatment strategies are presented in the discussion.

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Extracranial Approaches to the Repair of Cerebrospinal Fluid Rhinorrhea

Ear Nose & Throat Journal ◽

10.1177/014556139207100706 ◽

1992 ◽

Vol 71 (7) ◽

pp. 311-313 ◽

Cited By ~ 13

Author(s):

David T. Daly ◽

William M. Lydiatt ◽

Frederic P. Ogren ◽

Gary F. Moore

Keyword(s):

Cerebrospinal Fluid ◽

Conservative Management ◽

Imaging Techniques ◽

Bony Defect ◽

Dural Defect ◽

Recurrent Meningitis ◽

Csf Rhinorrhea ◽

Cerebrospinal Fluid Rhinorrhea ◽

Continuous Drainage ◽

The Common

This paper presents a review of the extracranial evaluation and treatment of cerebrospinal fluid (CSF) rhinorrhea. Diagnosis with attention to a careful history and physical with maneuvers which exacerbate drainage and thorough physical exam along with imaging techniques are discussed. The common etiologies of CSF rhinorrhea including trauma, spontaneous leakage, tumor, and iatrogenic injury are included. Management consists of conservative measures including the avoidance of straining maneuvers which increases intracranial pressure. Periodic drainage of CSF via lumbar puncture or continuous drainage via flow-regulated systems may also be of benefit in attempts of conservative management. Failure of conservative management, constant leakage, pneumocephalus, and recurrent meningitis are indicators for surgical repairs. Ethmoid-cribiform plate region repairs are generally approached by external ethmoidectomy and the development of mucoperiosteal flaps from various donor sites which are then rotated to the leak area to seal the defect. Frontal sinus leaks are usually repaired via an osteoplastic flap technique with direct repair of the dural defect or the use of fascial graft tucked under the bony defect, then obliterated with abdominal fat. CSF rhinorrhea presents a diagnostic and surgical challenge to the otolaryngologist. After diagnosis and localization, operative repair using extracranial approaches is accepted as the initial method of intervention in these cases.

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Intrasphenoidal Encephalocele Associated with Cerebrospinal Fluid Fistula and Subdural Hematomas: Technical Case Report

Neurosurgery ◽

10.1227/01.neu.0000065183.05896.9c ◽

2003 ◽

Vol 52 (6) ◽

pp. 1487-1490 ◽

Cited By ~ 11

Author(s):

Bernardo Fraioli ◽

Carlo Conti ◽

Pierpaolo Lunardi ◽

Giovanni Liccardo ◽

Mario Francesco Fraioli ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Procedure ◽

Cerebrospinal Fluid Leakage ◽

Bony Defect ◽

Computed Tomographic ◽

Fluid Leakage ◽

Subdural Hematomas ◽

Total Disappearance ◽

Intrasphenoidal Encephalocele

Abstract OBJECTIVE AND IMPORTANCE Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.

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Computed tomographic anatomy of the nasal cavity, paranasal sinuses and tympanic cavity of the koala

Australian Veterinary Journal ◽

10.1111/avj.12098 ◽

2013 ◽

Vol 91 (9) ◽

pp. 353-365 ◽

Cited By ~ 4

Author(s):

S Hemsley ◽

H Palmer ◽

RB Canfield ◽

MEB Stewart ◽

MB Krockenberger ◽

...

Keyword(s):

Nasal Cavity ◽

Paranasal Sinuses ◽

Tympanic Cavity ◽

Computed Tomographic

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Resolution of primary spontaneous cerebrospinal fluid rhinorrhea after computed tomographic cisternography

Otolaryngology ◽

10.1016/s0194-5998(97)70305-x ◽

1997 ◽

Vol 116 (4) ◽

pp. 533-535

Author(s):

M BRIGHAM ◽

K KORZEC ◽

J YOBBAGY

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Rhinorrhea ◽

Computed Tomographic

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Treatment of Cerebrospinal Fluid Rhinorrhea by Percutaneous Lumboperitoneal Shunting: Review of 15 cases

Neurosurgery ◽

10.1097/00006123-198501000-00009 ◽

1985 ◽

Vol 16 (1) ◽

pp. 44-47 ◽

Cited By ~ 1

Author(s):

Philippe Bret ◽

Frédéric Hor ◽

Claude Lapras ◽

Georges Fischer

Keyword(s):

Cerebrospinal Fluid ◽

Direct Methods ◽

Csf Leak ◽

Communicating Hydrocephalus ◽

Benign Intracranial Hypertension ◽

Cerebrospinal Fluid Rhinorrhea ◽

Computed Tomographic ◽

Additional Surgery ◽

Shunt Removal ◽

Spinal Catheter

Abstract Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides and attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed. (Neurosurgery 16:44–47, 1985)

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