Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

2021 ◽  
pp. 194589242110609
Author(s):  
Michael Xie ◽  
Kelvin Zhou ◽  
Shamez Kachra ◽  
Tobial McHugh ◽  
Doron D. Sommer
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Case Series ◽  
Csf Rhinorrhea ◽  
Radionuclide Cisternography ◽  
Contrast Enhanced ◽  
Magnetic Resonance Cisternography

Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

Skull Base Cerebrospinal Fluid Fistulas: A Comprehensive Diagnostic Algorithm

2002 ◽  
Vol 126 (6) ◽  
pp. 669-676 ◽  
Author(s):  
Jeffrey S. Zapalac ◽  
Bradley F. Marple ◽  
Nathan D. Schwade
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
High Resolution ◽  
Skull Base ◽  
Diagnostic Algorithm ◽  
Cost Effective ◽  
Diagnostic Approach ◽  
Csf Leak ◽  
High Resolution Computed Tomography ◽  
Magnetic Resonance Cisternography

OBJECTIVE: Our goal was to assess the efficacy of current diagnostic modalities in the management of skull base cerebrospinal fluid (CSF) fistulas. METHODS: We conducted a retrospective review of all patients presenting to our institution over the past 6 years with skull base CSF fistulas. RESULTS: Fifty-two patients were included in the study. β2-Transferrin analysis of collected specimen was the most efficacious means of confirming a CSF leak. High-resolution computed tomography was the most informative radiographic study, yielding a sensitivity and an accuracy of 87%. Magnetic resonance cisternography, yielding a sensitivity and an accuracy of 78%, was instrumental in localizing the site of leak for a few cases but was most commonly corroborative. Using a graduated diagnostic approach, successful repair was attained in 88% of cases after 1 attempt and 98% after 1 or 2 attempts. CONCLUSION: For patients with skull base CSF fistulas, a graduated diagnostic approach with emphasis on confirmation of leak by β2-transferrin analysis and precise localization by high-resolution computed tomography is both efficacious and cost effective.

LOCALIZATION OF CEREBROSPINAL FLUID LEAKS BY GADOLINIUM-ENHANCED MAGNETIC RESONANCE CISTERNOGRAPHY

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 584-589 ◽  
Author(s):  
Kubilay Aydin ◽  
Ege Terzibasioglu ◽  
Serra Sencer ◽  
Altay Sencer ◽  
Yusufhan Suoglu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Vital Signs ◽  
Imaging Method ◽  
Csf Rhinorrhea ◽  
Mr Cisternography ◽  
Csf Leakage ◽  
Dural Tears ◽  
Magnetic Resonance Cisternography ◽  
Csf Leaks

Abstract OBJECTIVE Intrathecal gadolinium (Gd)-enhanced magnetic resonance (MR) cisternography is a newly introduced imaging method. Two main objectives of this study were to investigate the sensitivity of Gd-enhanced MR cisternography for presurgical localization of cerebrospinal fluid (CSF) leaks in patients with CSF rhinorrhea and to study the potential long-term adverse effects of intrathecal Gd application. METHODS Fifty-one patients (19 women; mean age, 36.2 yr) with CSF rhinorrhea were included in the study. A total of 0.5 ml of Gd was injected into the lumbar subarachnoid space. T1-weighted MR cisternographic images were obtained to detect CSF leakage. The patient's neurological states and vital signs were recorded for the first 24 hours after the procedure. Neurological evaluations were repeated 1, 3, and 12 months after the procedure. The patients were followed for at least 3 years with annual neurological examinations. RESULTS Gd-enhanced MR cisternography demonstrated CSF leaks in 43 of the 51 patients. The sensitivity of Gd-enhanced MR cisternography for localization of CSF leaks was 84%. Forty-four patients underwent surgery to repair dural tears. Surgical findings confirmed the results of Gd-enhanced cisternography in 43 of the 44 patients who underwent surgery (98%). Eight patients with negative Gd-enhanced MR cisternography had no active rhinorrhea at the time of procedure, and seven of them did not need surgery. None of the patients developed an acute adverse reaction that could be attributed to the procedure. None of the patients developed any neurological symptoms or signs caused by intrathecal Gd injection during a mean follow-up period of 4.12 years. CONCLUSION Gd-enhanced MR cisternography is a sensitive and safe imaging method for detection of CSF leaks in patients with rhinorrhea.

Magnetic Resonance Cisternography and Thin Coronal Computerized Tomography in the Evaluation of Cerebrospinal Fluid Rhinorrhea

1997 ◽  
Vol 11 (5) ◽  
pp. 387-392 ◽  
Author(s):  
Michael J. Sillers ◽  
C. Elliott Morgan ◽  
Taher El Gammal
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Lumbar Puncture ◽  
Computerized Tomography ◽  
Contrast Study ◽  
Precise Localization ◽  
Csf Rhinorrhea ◽  
Spin Echo Sequence ◽  
Magnetic Resonance Cisternography ◽  
Csf Leaks

In recent years cerebrospinal fluid (CSF) rhinorrhea has been managed successfully with transnasal endoscopic techniques. The most important and often most difficult step is the precise localization of the fistula. Computerized tomographic and radionuclide cisternography are two commonly used techniques for preoperative identification of the CSF fistula when it cannot be seen clearly with nasal endoscopy. Each of these requires a lumbar puncture, and the intrathecal placement of contrast material has been associated with transient neurotoxicities. Magnetic resonance cisternography (MRC) is a non-contrast study that does not require a lumbar puncture and has been used recently in the diagnosis of spontaneous and traumatic CSF leaks. Magnetic resonance cisternography utilizes a fast spin-echo sequence with fat suppression and video image reversal that highlights CSF. This allows precise localization of the fistula in both coronal and sagittal planes. Thin section coronal computed tomography (TCCT) is another noninvasive technique that can be helpful in localizing CSF leaks. The technique of MRC and TCCT and the results of 16 CSF leaks in 15 patients are reported. There was good correlation between MRC, TCCT, and intraoperative findings. Magnetic resonance cisternography and thin coronal computerized tomography appear to be accurate and complementary, noninvasive radiographic studies that should be considered in the evaluation CSF rhinorrhea.

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