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Fistula detection in cerebrospinal fluid leakage
Journal of Neurology, Neurosurgery, and Psychiatry
|October 1, 1972
Summary
Positive contrast ventriculography successfully identified cerebrospinal fluid (CSF) fistulae when scinticisternography failed. This technique is valuable for diagnosing CSF rhinorrhoea, especially when adhesions obstruct the subarachnoid space.
Area of Science:
- Neurosurgery
- Radiology
- Neurology
Background:
- Cerebrospinal fluid (CSF) rhinorrhoea presents diagnostic challenges.
- Traditional imaging like scinticisternography may not always identify the fistulae.
- Adhesions can complicate the assessment of CSF leak pathways.
Purpose of the Study:
- To evaluate positive contrast ventriculography as an alternative diagnostic method for CSF rhinorrhoea.
- To demonstrate CSF fistulae when conventional methods fail.
- To investigate the role of adhesions in CSF leak pathways.
Main Methods:
- Two cases of suspected CSF rhinorrhoea were investigated.
- Scinticisternography was performed but failed to locate the fistulae.
- Positive contrast ventriculography was utilized to visualize the tracts.
- Surgical exploration was conducted in one case.
- Ventriculoatrial shunt insertion was performed in one case.
Main Results:
- Positive contrast ventriculography successfully demonstrated the fistulae in both cases.
- One case showed evidence of adhesions isolating the fistula from the subarachnoid space.
- One case presented with 'high pressure rhinorrhoea'.
- Rhinorrhoea resolved after ventriculoatrial shunt insertion.
Conclusions:
- Positive contrast ventriculography is an effective method for diagnosing CSF fistulae when scinticisternography is inconclusive.
- The technique can help identify complex fistulae, potentially involving adhesions.
- Management with CSF diversion, such as a ventriculoatrial shunt, can resolve high-pressure CSF rhinorrhoea.