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CSF Leakage "Radiology, Neuroradiology and Head and Neck, ENT"

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Introduction: Leak of CSF is a relatively common complication in skull base fractures and it is rarely seen during skull base tumors and pituitary gland pathologies "Adenomas and empty sellae syndrome"."nThe common site of CSF leakage is related to the site of fracture but it is more common in cribriform plate fractures. Other sites are frontal sinus fractures and rarely sphenoid sinus lesions related to pituitary gland site pathology. Evaluation of the cribriform plate and the posterior wall of the frontal sinus is an imaging key point."nOther rare conditions of CSF leak are related to temporal bone fractures leading to otorrhea and in a paradoxical feature with rhinorrhea "intact tympanic membrane with temporal bone fracture and eustachian tube transmission of fluid"."nEthiology "nTrauma and skull base fractures epecially in the cribriform plate."nParanasal sinus fractures specially in the frontal and sphenoidal sinuses."nTemporal bone fractures."nEmpty sellae and intrasellar tumors."nPost-op stage in the skull base tumors."nDiagnosis"nNasal CSF leakage laboratory."nRadioneucleid imaging: This way is sensitive but non-specific."nMethylen blue injection into CSF via lumbar puncture "non-specific" and rarely used."nHigh resolution axial, coronal and sagittal reconstructed images of skull base as a modality of choice"nIn case of positive CSF leak but negative spiral ultra-high resolution CT in PNS, ethmoidal region and cribriform plate also temporal bone cuts we need linear and pleuridirectional X-ray tomography."nIn case of positive CSF leakage and negative radiology and imaging it needs exploration surgery to direct vision of anterior fossa floor bones for fracture."n-Companion complication could be recurrent meningitis."n- No 3D-CT or MRI is necessary for bone fractures but MRI could be"nnecessary for related brain contusion or soft tissue lesions and tumor."nX-ray CT-cisternography"nAlthough more than 90% of fractures could be detected by multidirectional ultra-high resolution bone CT of the skull base, CT-cisternography is used to show the CSF leak point and CSF reservoir in sinuses or ethmoidal cells."n- In our experiments all positive cases diagnosed by CT-cisternography were detected by UHRCT of the bone and no positive cisternography was detected after negative plain UHRCT."nCoronal UHRCT is the more important and sensitive method mode for the diagnosis of the leak point."nInjection of 15cc non-ionic contrast media like ultravist 300 into CSF via lumbar puncture increases about 100-110 hounsfield units density of leaked CSF via active leak point

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