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The value of 3D-FIESTA MRI in detecting non-iatrogenic cerebrospinal fluid rhinorrhoea: correlations with endoscopic endonasal surgery

  • Clinical Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

In this study, we investigated the value of three-dimensional (3D) fast-imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) in detecting non-iatrogenic cerebrospinal fluid (CSF) rhinorrhoea and compared it with regular MRI and 3D magnetisation prepared rapid acquisition gradient echo (MPRAGE) MRI sequences, as well as high-resolution computed tomography (HRCT) imaging. We also present the endoscopic experiences of such cases.

Method

From June 2011 to Feb 2016, 17 patients with non-iatrogenic cerebrospinal fluid rhinorrhoea were included. Seven patients had spontaneous rhinorrhoea, three patients had invasive tumours, and the remaining patients had traumatic aetiologies. All the patients underwent HRCT, regular MRI sequence imaging, 3D-MPRAGE MRI sequence imaging and 3D-FIESTA MRI sequence imaging for the preoperative evaluations of the leakages. For each patient, the CSF fistula site was confirmed by intraoperative neuronavigation and endoscopic findings. Statistical analyses were performed. All patients underwent endoscopic multilayer repair.

Results

The sensitivities of the HRCT, regular MRI (T1 and T2), 3D-MPRAGE and 3D-FIESTA modalities for identifying CSF leakage were 58.8 %, (11.8 % and 29.4 %), 74.7 %, and 88.2 %, respectively. The origins of the leakages included the cribriform plate (18 %), ethmoidal fovea (23 %), lateral recess of the sphenoid (17 %), sellar floor (12 %), ethmoidal roof (12 %), junction of the fovea and cribriform plate (6 %) and the junction of sellar and sphenoidal planum (6 %). Two patients required repair. The first was under local anaesthesia when the nasal packing was removed, and the second underwent repair at the same site a half-year later due to hydrocephalus. Lumbar drainage was performed in all cases. No major complications were encountered.

Conclusions

The endoscopic endonasal approach is safe and effective for the treatment of CSF rhinorrhoea. The 3D-FIESTA MR modality is superior to 3D-MPRAGE MR and HRCT in the depiction of the CSF fistula site. Due to its non-invasive and reliable properties, 3D-FIESTA MR should be the preferred preoperative examination for the patients with non-iatrogenic CSF rhinorrhoea.

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Authors and Affiliations

  1. Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China

    Tao Xie, Xiaobiao Zhang, Tengfei Liu, Hailing Ding, Fan Hu, Yong Yu & Ye Gu

  2. Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China

    Wei Sun

  3. Digital Medical Research Center, Fudan University, Shanghai, China

    Xiaobiao Zhang

  4. Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China

    Xiaobiao Zhang

Authors
  1. Tao Xie
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  2. Wei Sun
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  3. Xiaobiao Zhang
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  4. Tengfei Liu
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  5. Hailing Ding
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  6. Fan Hu
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  7. Yong Yu
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  8. Ye Gu
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Corresponding author

Correspondence to Xiaobiao Zhang.

Ethics declarations

This study was approved by the institutional ethics committee.

Funding

This study was supported by the National key research and development program, China (Grant No. 2016YFC0106103), the Shanghai Committee of Science and Technology, China (Grant No. 134119a1202) and Shanghai Health and Family Planning Commission, China (Grant No. 20134200). The sponsor had no role in the design or conduct of this research.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Informed consent

Written informed consent was obtained from each participant before entering the study.

Additional information

Tao Xie and Wei Sun contributed equally to this study.

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Xie, T., Sun, W., Zhang, X. et al. The value of 3D-FIESTA MRI in detecting non-iatrogenic cerebrospinal fluid rhinorrhoea: correlations with endoscopic endonasal surgery. Acta Neurochir 158, 2333–2339 (2016). https://doi.org/10.1007/s00701-016-2988-9

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  • DOI: https://doi.org/10.1007/s00701-016-2988-9

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