Published ahead of print on December 13, 2007
doi: 10.3174/ajnr.A0840
Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients
B. Schuknechta,
D. Simmenb,
H.R. Brinerb and
D. Holzmannc
a MRI Medical Radiological Institute Zurich, Bethanien Clinic and Bahnhofplatz, Zurich, Switzerland
b Center for Otology, Skull Base Surgery, Rhinology and Facial Plastic Surgery, The Hirslanden Clinic, Zurich, Switzerland
c Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
View larger version (68K):
[in this window]
[in a new window]
|
Fig 1. A–C, A 52-year-old man (patient 2) with intermittent CSF rhinorrhea for 2 months. A coronal high-resolution bone window noncontrast CT (A) early in this series reveals a soft tissue lesion within the right olfactory cleft adjacent to an osseous defect at the cribriform plate. After intrathecal administration of contrast material (B), a small loculation of contrast material is visualized (arrow) surrounded by isoattenuation of soft tissue. Endoscopic surgery revealed an arachnoid lined pouch within the olfactory cleft (C).
| |
View larger version (94K):
[in this window]
[in a new window]
|
Fig 2. A, B, Sagittal high-resolution bone window image depicts a 2-mm defect within the cribriform plate (arrow) in a 30-year-old patient with 4 months of intermittent CSF rhinorrhea (patient 8). The coronal T2-weighted image reveals a normal olfactory cleft. Isointense arachnoid tissue and CSF loculation originate from the junction of the cribriform plate and lamella lateralis and herniate into the frontal recess (long arrow) down to the middle meatus (long arrow). Proximity of the osteodural defect to the entrance point of the ethmoid artery is shown (short arrow).
| |
View larger version (79K):
[in this window]
[in a new window]
|
Fig 3. A, B, Coronal high-resolution bone window CT image (A) depicts a small erosion of the inferolateral recess (arrow) in a 70-year-old woman (patient 18) with massive intermittent CSF rhinorrhea for 7 months. The coronal T2-weighted MR image (B) shows a fluid level within the left sphenoid sinus, air within ventricles, and an air bubble below the left inferior temporal gyrus. Adjacent subcortical gliotic changes are present. A lesion with soft tissue isointense components and CSF is shown (long arrow), which corresponded to endoscopy, and histologic examination proved the presence of arachnoid tissue.
| |
View larger version (162K):
[in this window]
[in a new window]
|
Fig 4. A–D, An 18-year-old man with 1 episode of CSF rhinorrhea (patient 22). CT images depict arachnoid pits lateral to sphenoid sinus and osseous erosion lateral to the foramen rotundum (short arrow). The coronal T2-weighted image (C) reveals a CSF-filled pouch extending into the right inferolateral recess with some arachnoid strands (arrow). The endoscopic image (D, view from medial) depicts an arachnoid pouch (arrow) bulging into the sinus lumen.
| |
View larger version (71K):
[in this window]
[in a new window]
|
Fig 5. A–E, A 38-year-old woman (patient 24) with a history of meningitis 2 months ago. After sudden onset of a headache, the axial CT (A, B) shows a fluid level within the sphenoid sinus and subarachnoid air in the right prepontine and suprasellar cistern. At 14 days later after referral for further evaluation, sagittal CT (C) shows an aerated sinus and a small osseous defect within the posterior wall of the sphenoid sinus (arrow). Sagittal T2 and T1-weighted MR images (D, E) depict a small lesion (arrow) that herniates into the sphenoid sinus. Only in the clinical setting of CSF rhinorrhea the lesion is suspected to correspond to arachnoid herniation.
| |
