Ashish Rajendra Khandelwal MD, Presenter: Nothing to Disclose

Paramjeet Singh MD, Abstract Co-Author: Nothing to Disclose

Khandelwal Niranjan MD, Abstract Co-Author: Nothing to Disclose

Ashok Gupta MChir, FRCPC, Abstract Co-Author: Nothing to Disclose

Sunil Gupta MChir, FRCPC, Abstract Co-Author: Nothing to Disclose

Sudesh Prabhakar, Abstract Co-Author: Nothing to Disclose

 To identify spectrum of imaging and clinical findings in traumatic and spontaneous onset CSF rhinorrhoea groups.  To compare the efficacy of Intrathecal Gadolinium enhanced MR Cisternography (IGMRC) and CT cisternography (CTC) in fistulae localisation    

 22 patients ranging in age from 15 to 61 years (n=13 [59.1%] males and n=9 [40.9%] females) with biochemically confirmed CSF rhinorrhoea were studied. Imaging was performed on a 1.5 T MRI and 4 slice CT scanner. After taking informed consent, lumbar puncture was done followed by intrathecal injection of 8 ml of Omnipaque (300mgI/ml) mixed with 0.5 ml of Gadolinium DTPA. CT in coronal plane and T1 fat suppressed images in sagittal and coronal plane were performed.Precontrast studies with identical parameters were also done. CSF fistulae were confirmed at surgery.

• Traumatic rhinorrhoea seen in 11(50%) patients, was more common in younger patients (<40 years; 66.7%) and males (69.2%). • In spontaneous CSF rhinorrhea group comprising 11(50%) patients with no history of trauma, majority were females (n=8; 88.9%), in age group >40 years (70%). They had unique findings like empty sella (n=9; 81.81%), concave outward wall of sphenoid sinus (n=3; 27.27%), arachnoid granulation (n=4; 36.36%), increased CSF around optic nerves (n=3; 27.27%) and generalized cerebral atrophy (n=1; 9%). • Cribriform plate defects (spontaneous-81.8% vs. traumatic-27.3%), fovea ethmoidalis (spontaneous-18.2% vs. traumatic-nil) defects were significantly associated (p=0.01) with spontaneous onset CSF rhinorrhoea. Frontal, sphenoid and ethmoid sinus leaks were commoner in traumatic group. • Bony defect was seen in 90.9% of spontaneous onset rhinorrhoea vs. 54.5% of traumatic patients. Other imaging features without etiology predilection included brain/meningeal herniation, sinusitis and linear tract of contrast. • Sensitivity of IGMRC was 100% and of CTC was 88.2% for site localisation.

 Age, sex distribution and imaging spectrum of traumatic and spontaneous rhinorrhoea differ from each other. Both CTC and IGMRC are effective methods for localisation of leak.

Differentiation of the underlying etiology helps in reducing rate of recurrence after surgery. Study shows importance of both CTC and IGMRC as effective tools for CSF fistula site localisation.

Khandelwal, A, Singh, P, Niranjan, K, Gupta, A, Gupta, S, Prabhakar, S, Comparative Evaluation of Spontaneous and Traumatic CSF Rhinorrhoea on Intrathecal Gadolinium-enhanced MRI and CT Cisternography with Endoscopic Surgical Correlation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011261.html