Neurosurgical Approaches to Cerebrospinal Fluid Rhinorrhea

The evolutionary concepts of pinpointing and treating cerebrospinal fluid (CSF) fistulas over the past few decades are reviewed taking into consideration the dynamic character of CSF circulation. The localization of the site of leakage is greatly facilitated by the judicious use of a variety of radioisotope and radiological techniques. The most recent are Metrizamide CT Cisternography and Magnetic Resonance Imaging. It is asserted that still the most challenging cases are those with intermittent liquorrheas, and those patients in which the site of the fistula is not easily defined. The authors will describe their personal experience with intracranial surgical repair of fistulas located in the anterior fossa.

Localisation of a CSF fistula by metrizamide CT cisternography

Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted theutility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.

Communicating Triventricular Hydrocephalus and Its Treatment with a Lumboperitoneal Shunt

With computed tomography, triventricular hydrocephalus shows enlargement of the 3rd and both lateral ventricles with a nearly normal size 4th ventricle. Triventricular hydrocephalus has been described as noncommunicating because of aqueductal stenosis or obstruction. The authors, however, have encountered three patients whose computed tomographic (CT) images were those of triventricular hydrocephalus despite a patent aqueduct. This condition may be suitably referred to as communicating triventricular hydrocephalus because in all cases metrizamide CT cisternography demonstrated the communication between the spinal subarachnoid space and both lateral ventricles. The authors discuss its treatment with a lumboperitoneal shunt.