Name : ----------------
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Resident of ENT: Behzad Abedin
Resident of Radiology: Samira Shahhamzei
Gender : Female
Age : 26
Head & Neck Imaging
A 26 Y/O woman with previous hx of antrostomy and ethmoidectomy due to panpolyposis , presents with recurrent meningitis in last 1 year . CT cisternography is obtained.
Imaging Procedures and Findings
This coronal CT cisternogram demonstrates a cerebrospinal fluid leak through the cribriform plate (arrow in figure 3) , which was clinically suspected. Evidence of previous surgery (antrostomy and ethmoidectomy ) is visible . This patient is treated with bone and mucosal graft .
Cerebrospinal fluid (CSF) leak may occur from the nose (rhinorrhea), from the external auditory canal (otorrhea), or from a traumatic or operative defect in the skull or spine.The fluid leak is a result of meningeal dural and arachnoid laceration with fistula formation. Blunt trauma is the most common cause. All methods of cisternography??radionuclide, CT, and MR??provide improved or optimal CSF fistula detection when the fistula is active and when a Valsalva maneuver or jugular venous compression is added to the imaging protocol. CSF fistula can usually be demonstrated by using some method of cisternography, but localization of the leak to the right or left nasal cavity may be difficult because of the tendency of the fluid to cross sides and flow from both nostrils.
CSF leak from cribiform plate
Hugh J F Robertson, MD, DMR, FRCPC, FRCR, FACR, Professor Emeritus of Radiology, Professor of Clinical Radiology, Louisiana State University Health Sciences Center, New Orleans; Cerebrospinal Fluid Leak Imaging; Oct 26, 2009