Intrathecal Contrast-enhanced Computed Tomography and MR Cisternography for Skull Base Cerebrospinal Fluid Leaks and Other Intracranial Applications

Abstract

Acquired skull base cerebrospinal fluid (CSF) leaks can result from trauma, tumors, iatrogenic causes, or may be spontaneous. Spontaneous skull base CSF leaks are likely a manifestation of underlying idiopathic intracranial hypertension. The initial assessment of rhinorrhea or otorrhea, which may be suspected owing to an acquired skull base CSF leak, requires integration of clinical assessment and biochemical confirmation of CSF. When leaks are multiple or if samples of fluid cannot be obtained for testing, then recourse to intrathecal contrast-enhanced cisternography may be necessary. We also review various other applications for diagnosis of intracranial abnormalities using contrast-enhanced cisternography.

Keywords: CSF leak; CSF otorrhea; CSF rhinorrhea; Computed tomography cisternography; Gadolinium-enhanced magnetic resonance cisternography; Idiopathic intercranial hypertension; Intrathecal contrast medium.