LOCALIZATION OF CEREBROSPINAL FLUID LEAKS BY GADOLINIUM-ENHANCED MAGNETIC RESONANCE CISTERNOGRAPHY : A FIVE-YEAR SINGLE-CENTER EXPERIENCE OBJECTIVE: Intrathecal gadopentetate dimeglumine (Gd)-enhanced magnetic reso- nance (MR) cisternography is a newly introduced imaging method. Two main objec- tives of this study were to investigate the sensitivity of Gd-enhanced-MR cisternog- raphy for presurgical localization of cerebrospinal fluid (CSF) leaks in patients with CSF rhinorrhea and to study the potential long-term adverse effect(s) of intrathecal Gd application. METHODS: Fifty-one patients (19 women; mean age, 36.2 yr) with CSF rhinorrhea were included in the study. A total of 0.5 ml of Gd was injected into the lumbar subarach- noid space. T1-weighted MR cisternography images were obtained to detect CSF leak- age. Neurological states and vital signs of the patients were recorded for the first 24 hours after the procedure. Neurological evaluations were repeated 1, 3, and 12 months after the procedure. The patients were followed for at least 3 years with annual neuro- logical examinations. RESULTS: Gd-enhanced MR cisternography demonstrated CSF leaks in 43 of 51 patients. The sensitivity of Gd-enhanced MR cisternography for localization of CSF leaks was 84%. Forty-four patients underwent surgery to repair dural tears. Surgery findings con- firmed the results of Gd-enhanced cisternography in 43 of 44 patients who underwent surgery (98%). Eight patients with negative Gd-enhanced MR cisternography had no active rhinorrhea at the time of procedure, and 7 of them did not need surgery. No patient developed any acute adverse reaction that could be attributed to the procedure. None of the patients developed any neurological symptom or sign caused by intrathe- cal Gd injection during a mean follow-up period of 4.12 years. CONCLUSION: Gd-enhanced MR cisternography is a sensitive and safe imaging method for detection of CSF leaks in patients with rhinorrhea. KEY WORDS: Cisternography, CSF rhinorrhea, Gadolinium, Magnetic resonance imaging, Safety, Sensitivity Neurosurgery 00:000-000, 2008 DOI: 00-0000/00.NEU.0000000000.00000 www.neurosurgery-online.com NEUROSURGERY VOLUME 62 | NUMBER 3 | MARCH 2008 | 1 ?ARTICLE TYPE? Kubilay Aydin, M.D. Department of Neuroradiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey Ege Terzibasioglu, M.D. Department of Radiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey Serra Sencer, M.D. Department of Neuroradiology, Istanbul Medical School, Istanbul University, Istanbul, Turkey Altay Sencer, M.D. Department of Neurosurgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey Yusufhan Suoglu, M.D. Department of Otolaryngology, Istanbul Medical School, Istanbul University, Istanbul, Turkey Aykut Karasu, M.D. Department of Neurosurgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey Talat Kiris, M.D. Department of Neurosurgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey M. Inan Turantan, M.D. Department of Neurosurgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey Reprint requests: Kubilay Aydin, M.D., Adnan saygun cad, M.Salih rustu bey sok, Ulus Konaklari, No:8/12, Ulus, Istanbul, Turkey Email: dr.aydink@superonline.com; aydink@istanbul.edu.tr Received, Accepted, R hinorrhea is defined as the leakage of cerebrospinal fluid (CSF) from subarach- noid space into paranasal sinuses and subsequently into nasal cavity. Most cases of CSF rhinorrhea develop after an accidental and iatrogenic injury to the dura matter, although nontraumatic and spontaneous cases exist (16, 19). CSF leakage stops spontaneously within a week in approximately 70% of traumatic cases (5, 15). In persistent or recurrent cases, the CSF leakage site may be a port of entry for bacteria into subarachnoid space, subsequently leading to recurrent meningitis. In traumatic cases, the first choice of management is conservative treatment, including bed rest with head eleva- tion, diuretics, and lumbar drainage (16). In patients who do not respond to conservative treatment, surgical repair of dural tear is indi- cated. Presurgical radiological identification of CSF leakage site guides the surgeon during operation, increases the success rate of opera- tion, and decreases the risk of complications. Although anatomic resolutions of radiological imaging modalities have recently improved, Art #: NEU188276 0 tables, 4 B&W figs., 0 4/C figs. 2/1/08 Oper: RT Proof: 1