Cerebrospinal Fluid Leaks: A Case Series of Sinus Opacification on Computed Tomography (CT) Imaging

INTRODUCTION: Cerebrospinal fluid (CSF) leaks occur when fluid seeps through a dural or skull base defect, typically in the nose or ear. CSF leaks commonly are identified and diagnosed by use of computed tomography (CT) and CT cisternogram. CT findings suggestive of a CSF leak include a skull-based bone defect along with opacification of the contiguous sinus. This study examined a series of CSF leaks on CT imaging to document imaging findings. METHODS: A single-institution retrospective review of cases of CSF leak diagnosed by CT maxillofacial or CT cisternogram from January 1, 2008 to March 12, 2018 was performed. Patient demographics, history, imaging findings, and treatment were recorded. RESULTS: Thirty-nine patients met the inclusion criteria for the study. The average age was 51, and a large majority were female (76.9%). Among the 25 patients in which it was reported, the mean size of skull base defect was 0.472 cm. Of the 39 total cases, 27 patients (69.2%) presented with sinus opacification on CT imaging. CONCLUSIONS: Radiologists should be aware of the possibility of notable sinus opacification observable on CT when investigating a potential CSF leak. Opacification may vary in both location and size depending on the nature and location of a CSF leak. Further research is needed to draw a correlation between sinus opacification seen on CT scan and the diagnosed origin of a CSF leak.