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Positional MRI: a technique for confirming the site of leakage in cerebrospinal fluid rhinorrhoea
1Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi. mayank@medinst.ernet.in
Abstract:
We report confirmation of the site of leakage in two patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea by demonstrating CSF leaking on MRI. Both patients had midline anterior cranial fossa floor (cribriform plate/fovea ethmoidalis) dural-bone defects with arachnoid herniation with or without brain herniation into the upper part of the nasal cavity on MRI, which was subsequently confirmed surgically. Corresponding to the history of postural induction or aggravation of the rhinorrhoea, the CSF leak was demonstrated by the appearance of or increase in the sinonasal fluid collection by imaging the patient in the position of maximum leakage following initial images in the supine position.
Insights
This study confirms cerebrospinal fluid (CSF) leaks in patients with spontaneous CSF rhinorrhoea using MRI. Imaging in specific positions accurately identified the leak site at the anterior cranial fossa floor, aiding surgical confirmation.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Spontaneous cerebrospinal fluid (CSF) rhinorrhoea presents a diagnostic challenge.
- Accurate localization of CSF leaks is crucial for effective surgical intervention.
Observation:
- Two patients with spontaneous CSF rhinorrhoea were evaluated.
- MRI demonstrated CSF leakage at the midline anterior cranial fossa floor (cribriform plate/fovea ethmoidalis).
- Dural-bone defects with herniation into the nasal cavity were identified.
Findings:
- MRI successfully confirmed the site of CSF leakage in both patients.
- Imaging in positions of postural induction/aggravation revealed sinonasal fluid collection.
- Surgical confirmation correlated with MRI findings.
Implications:
- MRI, particularly with positional imaging, is a valuable tool for diagnosing spontaneous CSF rhinorrhoea.
- Precise localization enhances surgical planning and treatment outcomes.
- Understanding the role of dural-bone defects is key in managing these cases.