Abstract
The present article provides an overview of epidemiology, clinical signs and symptoms, imaging techniques and specific imaging findings in cerebrospinal fluid leaks. Imaging protocols are supplemented with practical hints for invasive techniques. Emphasis is on the full scope of imaging findings in traumatic and nontraumatic cranial and spinal leaks.
Zusammenfassung
Der vorliegende Artikel gibt einen Überblick über Epidemiologie, Klinik, Bildgebungstechniken und spezielle Befunde bei Liquorlecks. Untersuchungsprotokolle werden um praktische Hinweise für invasive Verfahren ergänzt. Schwerpunkt ist die ganze Breite der Bildgebung bei traumatischen und nichttraumatischen kranialen und spinalen Leckagen.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology 2008;248:725–36.
Abuabara A. Cerebrospinal fluid rhinorrhea: diagnosis and treatment. Med Oral Patol Cir Bucal 2007;12:e397–400.
Kim CH, Chung SK, Dhong HJ, Lee JI. Cerebrospinal fluid leakage after gamma knife radiosurgery for skull base metastasis from renal cell carcinoma: a case report. Laryngoscope 2008;118:1925–7.
Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol 1999;20:706–12.
Naumann A, Meyer JE, Gottschalk S, Wollenberg B, Gehrking E. Posttraumatisches Gusher-Phänomen nach Felsenbeinquerfraktur. HNO 2008;56:967–9.
Johnson F, Semaan MT, Megerian CA. Temporal bone fracture: evolution and management in the modern area. Otolaryngol Clin North Am 2008;41:597–618.
Bachmann-Harilstad G. Diagnostic values of beta-2 transferrin and beta-trace protein as markers for cerebrospinal fluid fistula. Rhinology 2008;46:82–5.
Risch L, Lisec I, Jutzi M, Podvinec M, Landolt H, Huber AR. Rapid, accurate and non-invasive detection of cerebrospinal fluid leakage using combined determination of beta-trace protein in secretion and serum. Clin Chim Acta 2005;351:169–76.
Keerl R, Weber RK, Draf W, Wienke A, Schäfer SD. Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope 2004;114:266–72.
Bernal-Sprekelsen M, Bleda-Vásquez C, Carrau RL. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol 2000;14:257–9.
Eljamel MS, Foy PM. Acute traumatic CSF fistulae: the risk of intracranial infection. Br J Neurosurg 1990;4:381–5.
Adriani KS, van de Beek D, Brouwer MC, Spanjaard L, de Gans J. Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis 2007;45:e46–51.
Nahas Z, Tatlipinar A, Limb CJ, Francis HW. Spontaneous meningoencephalocele of the temporal bone. Arch Otolaryngol Head Neck Surg 2008;134:509–18.
Schuknecht B, Simmen D, Briner HR, Holzmann D. Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging fidings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol 2008;29:542–9.
Chen CJ, Lee TH, Hsu HL, Tseng YC, Wong YC, Wang LJ. Spinal MR findings in spontaneous intracranial hypotension. Neuroradiology 2002;44:996–1003.
Schievink W. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286–96.
LaFata V, McLean N, Wise SK, DelGaudio JM, Hudgins PA. CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings. AJNR Am J Neuroradiol 2008;29:536–41.
Sharma P, Sehgal AD. Water-soluble contrast CT cisternography in CSF fistulas. Australas Radiol 1991;35:324–6.
Practice guideline for the performance of myelography and cisternography. American College of Radiology practice guideline (resolution 20). Reston: American College of Radiology, 2008:217–21.
Aydin K, Terzibasioglu E, Sencer S, Sencer A, Suoglu Y, Karasu A, Kiris T, Turantan MI. Localization of cerebrospinal fluid leaks by gadolinium-enhanced magnetic resonance cisternography: a 5-year single-center experience. Neurosurgery 2008;62:584–9.
Tittel A, Paris S, Meier U, Seidl R, Mutze S. Kontrastmittelverstärkte MRT-Zisternographie zur Detektion von Liquorfisteln nach frontobasaler Verletzung. Klin Neuroradiol 2001;11:122–9.
Abu-Alfa A. The impact of NSF on the care of patients with kidney disease. J Am Coll Radiol 2008;5:45–52.
Friedman JA, Ebersold MJ, Quast LM. Persistent posttraumatic cerebrospinal fluid leakage. Neurosurg Focus 2000;9:article 1.
Aletsee C; Konopik V, Dazert S, Dieler R. Operative Versorgung von Verletzungen der Frontorhinobasis. Laryngorhinootologie 2003;82:626–31.
Little SC, Kesser BW. Radiographic classification of temporal bone fractures. Arch Otolaryngol Head Neck Surg 2006;132:1300–4.
Popa GT. Mechanostruktur und Mechanofunktion der Dura mater des Menschen. Gegenbaurs Morphol Jahrb 1936;78:85–187.
Ondik MP, Benson AG, Djalilan H. An unusual site of a CSF leak following resection of a retrosigmoid acoustic neuroma. Ear Nose Throat J 2006;85:164–7.
Leong KS, Foy PM, Swift AC, Atkin SL, Hadden DR, MacFarlane IA. CSF rhinorrhea following treatment with dopamine agonists for massive prolactinomas. Clin Endocrinol (Oxf) 2000;52:43–9.
Nager GT. Cephaloceles. Laryngoscope 1987;97:77–84.
Hsu ML, Chen CY, Lien YH, Wang CC, Yuh YS, Chen SJ. Meningitis complicating an occult infected nasal epidermoid cyst in a child. J Neuroimaging 2002;12:187–9.
Currarino G, Maravilla KR, Salyer KE. Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications. AJNR Am J Neuroradiol 1985;6:39–43.
Jadhav AP, Nelson BD, Kim SS, Chiang VW. Cerebrospinal fluid rhinorrhea as a unique cause of hyponatremia. Pediatr Neurol 2007;37:360–2.
Schick B, Prescher A, Hofmann E, Steigerwald C, Draf W. Two occult skull base malformations causing recurrent meningitis in a child: a case report. Eur Arch Otorhinolaryngol 2003;260:518–21.
Castelnuovo P, Dallan I, Pistochini A, Battaglia P, Locatelli D, Bignami M. Endonasal endoscopic repair of Sternberg’s canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–9.
Pasquini E, Sciarretta V, Farneti G, Mazzatenta D, Modugno GC, Frank G. Endoscopic treatment of encephaloceles of the lateral wall of the sphenoid sinus. Minim Invasive Neurosurg 2004;47:209–13.
Helms J, Schwager K. Mittelohrmißbildungen. In: Naumann HH, Helms J, Herberhold C, Kastenbauer E, Hrsg. Oto-Rhino-Laryngologie in Klinik und Praxis, Bd 1: Ohr. Stuttgart: Thieme, 1994:545–63.
Gottschalk S, Gehrking E, Petersen D. Fehlbildungen des Felsenbeins. Clin Neuroradiol 2006;16:17–32.
Jégoux F, Malard O, Gayet-Delacroix M, Bordure P, Legent F, Beauvillain de Montreuil C. Hyrtl’s fissure: a case of spontaneous cerebrospinal fluid otorrhea. AJNR Am J Neuroradiol 2005;26:963–6.
Phelps PD, Proops D, Sellars S, Evans J, Michaels L. Congenital cerebrospinal fluid fistula through the inner ear and meningitis. J Laryngol Otol 1993;107:492–5.
Hoppe F, Hagen R, Hofmann E. Fistula of stapes footplate caused by pulsatile cerebrospinal fluid in inner ear malformation. J Otorhinolaryngol Relat Spec 1997;59:115–8.
Albayram S, Kilic F, Ozer H, Baghaki S, Kocer N, Islak C. Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome. Am J Neuroradiol 2008;29:116–21.
Author information
Authors and Affiliations
Corresponding author
Additional information
* Dedicated to the first author’s late teacher and mentor, Professor Maschallah Nadjmi, on the occasion of his 80th birthday.
Rights and permissions
About this article
Cite this article
Hofmann, E., Behr, R. & Schwager, K. Imaging of Cerebrospinal Fluid Leaks*. Clin Neuroradiol 19, 111–121 (2009). https://doi.org/10.1007/s00062-009-9008-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00062-009-9008-x