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CSF Leak Evaluation
Akiva Mintz, MD, PhD, MHA, CFA; Tejaswini Vasamsetty, MD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Escape of cerebrospinal fluid (CSF) from normal CSF space
              • Post-traumatic, iatrogenic, congenital, or spontaneous
              • CSF rhinorrhea, CSF otorrhea, CSF otorhinorrhea, CSF fistula, rhinoliquorrhea, pseudomeningocele
              • Causes spontaneous intracranial hypotension (SIH), intracranial hypotension (IH), CSF hypovolemia

          IMAGING

          • General Features

            • Nuclear Medicine Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Esposito F et al: Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery. 60(4 Suppl 2):295-303; discussion 303-4, 2007
                                2. Yilmazlar S et al: Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 29(1):64-71, 2006
                                3. Gladstone JP et al: Spontaneous CSF leak treated with percutaneous CT-guided fibrin glue. Neurology. 64(10):1818-9, 2005
                                4. Kerr JT et al: Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am. 38(4):597-611, 2005
                                5. Schlosser RJ et al: Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 114(2):255-65, 2004
                                6. Payne RJ et al: Role of computed tomographic cisternography in the management of cerebrospinal fluid rhinorrhea. J Otolaryngol. 32(2):93-100, 2003
                                7. Rice DH: Cerebrospinal fluid rhinorrhea: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg. 11(1):19-22, 2003
                                8. Mokri B et al: Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology. 58(5):814-6, 2002
                                9. Hegazy HM et al: Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 110(7):1166-72, 2000
                                10. Stone JA et al: Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 20(4):706-12, 1999
                                11. Stern RH et al: Scintigraphic cerebral spinal fluid leak study in a child with recurrent meningitis after resection of a frontal meningocele. Clin Nucl Med. 20(2):136-9, 1995
                                12. Lewis DH et al: Benefit of tomography in the scintigraphic localization of cerebrospinal fluid leak. J Nucl Med. 32(11):2149-51, 1991
                                13. Zu'bi SM et al: Intestinal activity visualized on radionuclide cisternography in patients with cerebrospinal fluid leak. J Nucl Med. 32(1):151-3, 1991
                                14. Primeau M et al: Spinal cerebrospinal fluid leak demonstrated by radioisotopic cisternography. Clin Nucl Med. 13(10):701-3, 1988
                                15. Curnes JT et al: CSF rhinorrhea: detection and localization using overpressure cisternography with Tc-99m-DTPA. Radiology. 154(3):795-9, 1985
                                16. Glaubitt D et al: Detection and quantitation of intermittent CSF rhinorrhea during prolonged cisternography with 111In-DTPA. AJNR Am J Neuroradiol. 4(3):560-3, 1983
                                17. Colletti PM et al: Posttraumatic lumbar cerebrospinal fluid leak: detection by retrograde in-111-DTPA myeloscintography. Clin Nucl Med. 6(9):403-4, 1981
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Imaging

                                  • Pathology

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Definitions

                                          • Escape of cerebrospinal fluid (CSF) from normal CSF space
                                            • Post-traumatic, iatrogenic, congenital, or spontaneous
                                            • CSF rhinorrhea, CSF otorrhea, CSF otorhinorrhea, CSF fistula, rhinoliquorrhea, pseudomeningocele
                                            • Causes spontaneous intracranial hypotension (SIH), intracranial hypotension (IH), CSF hypovolemia

                                        IMAGING

                                        • General Features

                                          • Nuclear Medicine Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Esposito F et al: Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery. 60(4 Suppl 2):295-303; discussion 303-4, 2007
                                                              2. Yilmazlar S et al: Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 29(1):64-71, 2006
                                                              3. Gladstone JP et al: Spontaneous CSF leak treated with percutaneous CT-guided fibrin glue. Neurology. 64(10):1818-9, 2005
                                                              4. Kerr JT et al: Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am. 38(4):597-611, 2005
                                                              5. Schlosser RJ et al: Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 114(2):255-65, 2004
                                                              6. Payne RJ et al: Role of computed tomographic cisternography in the management of cerebrospinal fluid rhinorrhea. J Otolaryngol. 32(2):93-100, 2003
                                                              7. Rice DH: Cerebrospinal fluid rhinorrhea: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg. 11(1):19-22, 2003
                                                              8. Mokri B et al: Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology. 58(5):814-6, 2002
                                                              9. Hegazy HM et al: Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 110(7):1166-72, 2000
                                                              10. Stone JA et al: Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 20(4):706-12, 1999
                                                              11. Stern RH et al: Scintigraphic cerebral spinal fluid leak study in a child with recurrent meningitis after resection of a frontal meningocele. Clin Nucl Med. 20(2):136-9, 1995
                                                              12. Lewis DH et al: Benefit of tomography in the scintigraphic localization of cerebrospinal fluid leak. J Nucl Med. 32(11):2149-51, 1991
                                                              13. Zu'bi SM et al: Intestinal activity visualized on radionuclide cisternography in patients with cerebrospinal fluid leak. J Nucl Med. 32(1):151-3, 1991
                                                              14. Primeau M et al: Spinal cerebrospinal fluid leak demonstrated by radioisotopic cisternography. Clin Nucl Med. 13(10):701-3, 1988
                                                              15. Curnes JT et al: CSF rhinorrhea: detection and localization using overpressure cisternography with Tc-99m-DTPA. Radiology. 154(3):795-9, 1985
                                                              16. Glaubitt D et al: Detection and quantitation of intermittent CSF rhinorrhea during prolonged cisternography with 111In-DTPA. AJNR Am J Neuroradiol. 4(3):560-3, 1983
                                                              17. Colletti PM et al: Posttraumatic lumbar cerebrospinal fluid leak: detection by retrograde in-111-DTPA myeloscintography. Clin Nucl Med. 6(9):403-4, 1981