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Imaging of Cerebrospinal Fluid Rhinorrhea

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Challenges in Rhinology

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Abstract

Cerebrospinal fluid (CSF) rhinorrhea is defined as the leakage of CSF into the nose through an osteodural defect in the skull base, which leads to a fistula between the subarachnoid space and the sinonasal cavity. Since this communication puts the patient at an increased risk of developing meningitis, surgical intervention is required for treatment of continuing CSF rhinorrhea. Accurate detection of the site of CSF leak facilitates appropriate treatment, helping to decrease the risk of life-threatening complications. Recent improvements in imaging technology, particularly the introduction of multi-detector computed tomography (CT), have led to better delineation of skull base defects. Imaging is crucial in precise localization and detailed evaluation of the leak, as demonstration of the exact location, size, and contents of the osteodural defect leads to more accurate planning of surgery. Also, radiological identification of critical adjacent anatomical structures before surgery increases the rate of surgical success with less morbidity. Imaging is essential for CSF rhinorrhea to identify the exact site of the leak, to characterize the osteodural defect, to plan surgery, and to evaluate the underlying cause. Various modalities including HRCT, MRI, and cisternography techniques using CT/MRI or radionuclide scan are described and widely used; however, there is no single best modality. HRCT scanning of the skull base is the modality of choice for depicting the bone defects; however, evaluation of the adjacent soft tissues is best achieved by MRI, making these two cross-sectional tools complementary to each other. HRCT images can also be used for intraoperative image-guided navigation.

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Authors and Affiliations

  1. Department of Radiology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Aslıhan Semiz-Oysu

  2. Department of Otorhinolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Aslı Şahin Yilmaz

  3. Division of Neuroradiology, Russel H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nafi Aygün

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  1. Aslıhan Semiz-Oysu
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  2. Aslı Şahin Yilmaz
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  3. Nafi Aygün
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Correspondence to Aslıhan Semiz-Oysu .

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Editors and Affiliations

  1. Department of Otolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

  2. Otolaryngology Department, Kırıkkale University, Faculty Medicine, Kirikkale, Turkey

    Nuray Bayar Muluk

  3. Royal National ENT Hospital, London, UK

    Glenis K Scadding

  4. Croatian Academy of Medical Sciences, Zagreb, Croatia

    Ranko Mladina

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Semiz-Oysu, A., Yilmaz, A.Ş., Aygün, N. (2021). Imaging of Cerebrospinal Fluid Rhinorrhea. In: Cingi, C., Bayar Muluk, N., Scadding, G.K., Mladina, R. (eds) Challenges in Rhinology. Springer, Cham. https://doi.org/10.1007/978-3-030-50899-9_21

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  • DOI: https://doi.org/10.1007/978-3-030-50899-9_21

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