Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-04T21:52:32.977Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

Published online by Cambridge University Press:  10 May 2021

T Hendriks ,
A Thompson ,
R Boeddinghaus ,
H E I Tan  and
J Kuthubutheen
T Hendriks*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Australia Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia School of Surgery, University of Western Australia, Nedlands, Australia
A Thompson
Affiliation:
Perth Radiological Clinic, Subiaco, Australia
R Boeddinghaus
Affiliation:
Perth Radiological Clinic, Subiaco, Australia Department of Surgery, University of Western Australia, Nedlands, Australia
H E I Tan
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia Radiology, Sir Charles Gairdner Hospital, Nedlands, Australia
J Kuthubutheen
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Australia Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia School of Surgery, University of Western Australia, Nedlands, Australia
*
Author for correspondence: Dr Thomas Hendriks, Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch6150, WA, Australia E-mail: [email protected]. Fax: +61 08 6457 4899
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and objective

Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak.

Methods

A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed.

Results

Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm).

Conclusion

Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

Keywords

Cerebrospinal Fluid Otorrhea, SpontaneousSkull BaseNeuro-OtologyTemporal BoneBrain Imaging
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 5 , May 2021 , pp. 403 - 409
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr T Hendriks takes responsibility for the integrity of the content of the paper

References

Nelson, RF, Gantz, BJ, Hansen, MR. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol 2015;36:476–80CrossRefGoogle ScholarPubMed
Hendriks, T, Bala, A, Rodrigues, S, Kuthubutheen, J. Spontaneous cerebrospinal fluid (CSF) otorrhoea in Western Australia—an emerging entity? Aust J Otolaryngol 2019;2CrossRefGoogle Scholar
Vemuri, NV, Karanam, LSP, Manchikanti, V, Dandamudi, S, Puvvada, SK, Vemuri, VK. Imaging review of cerebrospinal fluid leaks. Indian J Radiol Imaging 2017;27:441–6CrossRefGoogle ScholarPubMed
Rao, N, Redleaf, M. Spontaneous middle cranial fossa cerebrospinal fluid otorrhea in adults. Laryngoscope 2016;126:464–8CrossRefGoogle ScholarPubMed
Schlosser, RJ, Wilensky, EM, Grady, MS, Bolger, WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol 2003;17:191–5CrossRefGoogle ScholarPubMed
Schlosser, RJ, Bolger, WE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association. Am J Rhinol 2003;17:91–6CrossRefGoogle ScholarPubMed
Qahtani, BA. Spontaneous CSF otorrhea, hidden and serious condition necessitate recognition of its presentation and the modalities of treatment. Indian J Otol 2012;18:58–61CrossRefGoogle Scholar
Illing, E, Schlosser, RJ, Palmer, JN, Cure, J, Fox, N, Woodworth, BA. Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal. Int Forum Allergy Rhinol 2014;4:246–50CrossRefGoogle Scholar
Allen, KP, Perez, CL, Kutz, JW, Gerecci, D, Roland, PS, Isaacson, B. Elevated intracranial pressure in patients with spontaneous cerebrospinal fluid otorrhea. Laryngoscope 2014;124:251–4CrossRefGoogle ScholarPubMed
Stevens, SM, Rizk, HG, McIlwain, WR, Lambert, PR, Meyer, TA. Association between lateral skull base thickness and surgical outcomes in spontaneous CSF otorrhea. Otolaryngol Head Neck Surg 2016;154:707–14CrossRefGoogle ScholarPubMed
Stevens, SM, Lambert, PR, Rizk, H, McIlwain, WR, Nguyen, SA, Meyer, TA. Novel radiographic measurement algorithm demonstrating a link between obesity and lateral skull base attenuation. Otolaryngol Head Neck Surg 2015;152:172–9CrossRefGoogle ScholarPubMed
Shetty, PG, Shroff, MM, Fatterpekar, GM, Sahani, DV, Kirtane, MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000;21:337–42Google ScholarPubMed
Rabbani, C, Saltagi, MZ, Ye, MJ, Patel, JM, Manchanda, S, Nelson, RF. Association of obstructive sleep apnea with calvarial and skull base thinning. JAMA Otolaryngol Head Neck Surg 2018;144:513–18CrossRefGoogle ScholarPubMed
Psaltis, AJ, Overton, LJ, Thomas, WW 3rd, Fox, NF, Banks, CA, Schlosser, RJ. Differences in skull base thickness in patients with spontaneous cerebrospinal fluid leaks. Am J Rhinol Allergy 2014;28:e73–9CrossRefGoogle ScholarPubMed
Nelson, RF, Hansen, KR, Gantz, BJ, Hansen, MR. Calvarium thinning in patients with spontaneous cerebrospinal fluid leak. Otol Neurotol 2015;36:481–5CrossRefGoogle ScholarPubMed
Honda, N, Okouchi, Y, Sato, H, Sanuki, T, Hato, N, Yanagihara, N et al. Bilateral spontaneous cerebrospinal fluid otorrhea. Am J Otolaryngol 2004;25:68–72CrossRefGoogle ScholarPubMed
Gacek, RR, Gacek, MR, Tart, R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999;20:770–6Google ScholarPubMed
Meco, C, Oberascher, G, Arrer, E, Moser, G, Albegger, K. Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol Head Neck Surg 2003;129:508–17CrossRefGoogle ScholarPubMed
Stone, JA, Castillo, M, Neelon, B, Mukherji, SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol 1999;20:706–12Google ScholarPubMed
Lloyd, KM, DelGaudio, JM, Hudgins, PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology 2008;248:725–36CrossRefGoogle ScholarPubMed
Stucken, EZ, Selesnick, SH, Brown, KD. The role of obesity in spontaneous temporal bone encephaloceles and CSF leak. Otol Neurotol 2012;33:1412–17CrossRefGoogle ScholarPubMed
Rabbani, CC, Saltagi, MZ, Manchanda, SK, Yates, CW, Nelson, RF. Prevalence of obstructive sleep apnea (OSA) in spontaneous cerebrospinal fluid (CSF) leaks: a prospective cohort study. Otol Neurotol 2018;39:e475–80CrossRefGoogle ScholarPubMed
LeVay, AJ, Kveton, JF. Relationship between obesity, obstructive sleep apnea, and spontaneous cerebrospinal fluid otorrhea. Laryngoscope 2008;118:275–8CrossRefGoogle ScholarPubMed
Schuknecht, B, Simmen, D, Briner, HR, Holzmann, D. Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol 2008;29:542–9CrossRefGoogle ScholarPubMed
Leach, JL, Fortuna, RB, Jones, BV, Gaskill-Shipley, MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 2006;26(suppl 1):S19–41; discussion S2–3CrossRefGoogle ScholarPubMed
Degnan, AJ, Levy, LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 2011;32:1986–93CrossRefGoogle ScholarPubMed
Nelson, RF, Roche, JP, Gantz, BJ, Hansen, MR. Middle cranial fossa (MCF) approach without the use of lumbar drain for the management of spontaneous cerebral spinal fluid (CSF) leaks. Otol Neurotol 2016;37:1625–9CrossRefGoogle ScholarPubMed
Lobo, BC, Baumanis, MM, Nelson, RF. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol 2017;2:215–24CrossRefGoogle ScholarPubMed
Gonen, L, Handzel, O, Shimony, N, Fliss, DM, Margalit, N. Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects--case series and review of the literature. Neurosurg Rev 2016;39:141–50CrossRefGoogle ScholarPubMed
Sood, D, Rana, L, Chauhan, R, Shukla, R, Nandolia, K. Superior semicircular canal dehiscence: a new perspective. Eur J Radiol Open 2017;4:144–6CrossRefGoogle ScholarPubMed
Stevens, SM, Hock, K, Samy, RN, Pensak, ML. Are patients with spontaneous CSF otorrhea and superior canal dehiscence congenitally predisposed to their disorders? Otolaryngol Head Neck Surg 2018;159:543–52CrossRefGoogle ScholarPubMed
Allen, KP, Perez, CL, Isaacson, B, Roland, PS, Duong, TT, Kutz, JW. Superior semicircular canal dehiscence in patients with spontaneous cerebrospinal fluid otorrhea. Otolaryngol Head Neck Surg 2012;147:1120–4CrossRefGoogle ScholarPubMed
Nguyen, T, Lagman, C, Sheppard, JP, Romiyo, P, Duong, C, Prashant, GN et al. Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach. Acta Neurochir (Wien) 2018;160:1219–24CrossRefGoogle ScholarPubMed
Gubbels, SP, Selden, NR, Delashaw, JB Jr, McMenomey, SO. Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol 2007;28:1131–9CrossRefGoogle ScholarPubMed
Juliano, AF. Cross sectional imaging of the ear and temporal bone. Head Neck Pathol 2018;12:302–20CrossRefGoogle ScholarPubMed
Brady, AP. Error and discrepancy in radiology: inevitable or avoidable? Insights Imaging 2017;8:171–82CrossRefGoogle ScholarPubMed