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Temporal Bone CSF Leak
Patricia A. Hudgins, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • CSF otorhinorrhea, CSF fistula
            • Definitions

              • Leak of cerebrospinal fluid (CSF) either from acquired tegmen defect or congenital inner ear (IE) defect
                • Acquired tegmen tympani or mastoideum defect, resulting in leak of CSF into middle ear (ME)
                  • 2 main patient populations: Posttraumatic or idiopathic intracranial hypertension (IIH)
                • Congenital IE anomaly with perilymph fistula with CSF leak into ME cavity

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Nelson RF et al: Calvarium thinning in patients with spontaneous cerebrospinal fluid leak. Otol Neurotol. 36(3):481-5, 2015
                                        2. Remenschneider AK et al: Histopathology of idiopathic lateral skull base defects. Laryngoscope. 125(8):1798-806, 2015
                                        3. Kim L et al: Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol Head Neck Surg. 150(3):472-8, 2014
                                        4. Brainard L et al: Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak. Otol Neurotol. 33(9):1621-4, 2012
                                        5. Stucken EZ et al: The role of obesity in spontaneous temporal bone encephaloceles and CSF leak. Otol Neurotol. 33(8):1412-7, 2012
                                        6. Patel A et al: Management of temporal bone trauma. Craniomaxillofac Trauma Reconstr. 3(2):105-13, 2010
                                        7. Gubbels SP et al: Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol. 28(8):1131-9, 2007
                                        8. Placantonakis DG et al: Intradiploic cerebrospinal fluid fistulas of iatrogenic origin. Report of two cases. J Neurosurg. 104(5 Suppl):356-9, 2006
                                        9. Rao AK et al: Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol. 26(6):1171-5, 2005
                                        10. Stenzel M et al: Cerebrospinal fluid leaks of temporal bone origin: etiology and management. ORL J Otorhinolaryngol Relat Spec. 67(1):51-5, 2005
                                        11. Brown NE et al: Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope. 114(5):800-5, 2004
                                        12. Buchanan RJ et al: Traumatic cerebrospinal fluid fistulas. In Winn HR, ed. Youmans Neurological Surgery. 5th ed. Philadelphia: W. B. Saunders Co. 5265-72, 2004
                                        13. Kveton JF et al: Elimination of temporal bone cerebrospinal fluid otorrhea using hydroxyapatite cement. Laryngoscope. 110(10 Pt 1):1655-9, 2000
                                        14. 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
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • CSF otorhinorrhea, CSF fistula
                                                  • Definitions

                                                    • Leak of cerebrospinal fluid (CSF) either from acquired tegmen defect or congenital inner ear (IE) defect
                                                      • Acquired tegmen tympani or mastoideum defect, resulting in leak of CSF into middle ear (ME)
                                                        • 2 main patient populations: Posttraumatic or idiopathic intracranial hypertension (IIH)
                                                      • Congenital IE anomaly with perilymph fistula with CSF leak into ME cavity

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Nelson RF et al: Calvarium thinning in patients with spontaneous cerebrospinal fluid leak. Otol Neurotol. 36(3):481-5, 2015
                                                                              2. Remenschneider AK et al: Histopathology of idiopathic lateral skull base defects. Laryngoscope. 125(8):1798-806, 2015
                                                                              3. Kim L et al: Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol Head Neck Surg. 150(3):472-8, 2014
                                                                              4. Brainard L et al: Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak. Otol Neurotol. 33(9):1621-4, 2012
                                                                              5. Stucken EZ et al: The role of obesity in spontaneous temporal bone encephaloceles and CSF leak. Otol Neurotol. 33(8):1412-7, 2012
                                                                              6. Patel A et al: Management of temporal bone trauma. Craniomaxillofac Trauma Reconstr. 3(2):105-13, 2010
                                                                              7. Gubbels SP et al: Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol. 28(8):1131-9, 2007
                                                                              8. Placantonakis DG et al: Intradiploic cerebrospinal fluid fistulas of iatrogenic origin. Report of two cases. J Neurosurg. 104(5 Suppl):356-9, 2006
                                                                              9. Rao AK et al: Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol. 26(6):1171-5, 2005
                                                                              10. Stenzel M et al: Cerebrospinal fluid leaks of temporal bone origin: etiology and management. ORL J Otorhinolaryngol Relat Spec. 67(1):51-5, 2005
                                                                              11. Brown NE et al: Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope. 114(5):800-5, 2004
                                                                              12. Buchanan RJ et al: Traumatic cerebrospinal fluid fistulas. In Winn HR, ed. Youmans Neurological Surgery. 5th ed. Philadelphia: W. B. Saunders Co. 5265-72, 2004
                                                                              13. Kveton JF et al: Elimination of temporal bone cerebrospinal fluid otorrhea using hydroxyapatite cement. Laryngoscope. 110(10 Pt 1):1655-9, 2000
                                                                              14. 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