metrizamide and Cerebrospinal-Fluid-Rhinorrhea

The anterior skull base can be approached intranasally, and the development of endoscopes and accompanying endoscopic instruments in recent years makes possible extremely precise and defined work along the ethmoid and sphenoid sinus roof. Since these areas are the most frequent locations of anterior skull base CSF rhinorrhea, it follows that the localization and subsequent closure of these defects theoretically can be accomplished in this manner. Our report and others show that closure of CSF leaks can be accomplished successfully using this procedure, with minimal morbidity and at a fraction of the cost of frontal craniotomy. In our opinion, this should become the initial procedure of choice for closure of anterior fossa CSF leaks in amenable cases.

Topics: Adult; Cartilage; Cerebrospinal Fluid Rhinorrhea; Endoscopes; Endoscopy; Ethmoid Sinusitis; Female; Humans; Maxillary Sinusitis; Metrizamide; Nose; Postoperative Complications; Tomography, X-Ray Computed

We describe the case of a woman, who presents a spontaneous rhinorrhea. The metrizamid computerized tomographic cisternography proves the precise anatomic location of the dural osseous defect, in the left sphenoidal sinus. Transsphenoidal approach terminated the leakage in a single procedure, without shunt.

Topics: Cerebrospinal Fluid Rhinorrhea; Female; Humans; Magnetic Resonance Imaging; Metrizamide; Middle Aged; Pneumoencephalography; Sphenoid Sinus; Tomography, X-Ray Computed

Computerized tomography is usually adequate to explore supratentorial lesions of the skull and brain. However, it is often inadequate for a detailed analysis of lesions of the base of the skull and their anatomical rapports. Opacification of the subarachnoid spaces by means of a contrast medium (computerized cisternography) has proved extremely useful in such cases. The contrast media utilized are tri-iodized, water-soluble compounds which are well tolerated. The technique and anatomical data of the method are described, and its applications in different fields of tumoral and non-tumoral pathology are discussed.

Topics: Arachnoid; Brain Neoplasms; Brain Stem; Cerebrospinal Fluid Rhinorrhea; Cisterna Magna; Contrast Media; Craniopharyngioma; Cysts; Empty Sella Syndrome; Humans; Injections, Spinal; Iopamidol; Iothalamic Acid; Metrizamide; Neuroma, Acoustic; Pituitary Neoplasms; Tomography, X-Ray Computed

Topics: Cerebral Ventricle Neoplasms; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Choroid Plexus; Humans; Hydrocephalus; Metrizamide; Pentetic Acid; Radionuclide Imaging; Subarachnoid Space; Technetium; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed

Positive contrast cisternography with digital subtraction of fluoroscopy images before computed tomography (CT) was employed in the investigation of eight patients with cerebrospinal fluid (CSF) rhinorrhoea. Fistulae were visualised by preliminary digital subtraction cisternography (DSC) in six patients and in five patients the sites of leakage were confirmed at surgery. Fluoroscopy facilitated interpretation of CT in all the positive studies and in two patients provided information which could not be deduced from CT cisternography (CTC) alone. The combined technique is recommended for the investigation of patients with recurrent and post operative CSF rhinorrhoea and when CTC alone fails to identify the site of leakage.

Topics: Adult; Aged; Cerebrospinal Fluid Rhinorrhea; Female; Fluoroscopy; Humans; Male; Metrizamide; Middle Aged; Myelography; Paranasal Sinuses; Tomography, X-Ray Computed

This study evaluates the ability of metrizamide computerized tomographic cisternography (MCTC) to delineate the site of leakage in patients with cerebrospinal fluid (CSF) rhinorrhea. From 1981 to 1986, thirteen patients were examined by MCTC to localize the site of CSF leakage. A total of 17 studies were performed. Thirteen scans (76%) identified the site of CSF leakage. Nine of these scans were confirmed surgically. The other four scans were performed on patients who refused surgery. Of the 15 scans in patients with active CSF leaks, 13 (87%) were positive. Of the two patients with inactive CSF leaks, neither was positive. One patient is presented in whom MCTC was both diagnostic and therapeutic. In conclusion, MCTC has a high success rate in localizing the site of active CSF leaks.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Evaluation Studies as Topic; Female; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

The authors present their clinical observations on 25 children treated because of cerebrospinal fluid leakage. In an attempt to improve the detection of rhinorrhea, overpressure radionuclide cisternography (ORNC), combined with the placement of nasal pledgets, was employed in 20 cases. In 16 cases, metrizamide computed tomographic cisternography (MCTC) was performed. In 11 children both types of investigations were done. ORNC was performed as follows: after placing pledgets in each side of the nasopharynx, a lumbar puncture was done and opening, resting CSF pressure was continuously monitored. 99mTc-DTPA (1 ml, 0.5-3.0 mCi) was injected intrathecally and infusion of artificial CSF followed. MCTC was done 1 h after instillation of 5 ml of metrizamide. The rhinorrhea was diagnosed in 14 cases (all cases were verified through operation). In one case with negative ORNC, rhinorrhea was observed 1 week after examination and in the other 4 days after an additional head tap. In the group of MCTC, four results were true-positive, seven true-negative, and five false-negative. Concerning the group of ORNC and MCTC, four cases were false-negative with MCTC, but true-positive in ORNC. In seven cases EEG was performed immediately before and after ORNC and no changes were observed. There were no adverse effects following either type of investigation. In conclusion, the authors state that ORNC seems to be more sensitive in comparison to MCTC in diagnosis of intermittent rhinorrhea. MCTC, however, may be useful for precisely locating the CSF leakage.

Topics: Adolescent; Cerebrospinal Fluid Pressure; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Cisterna Magna; Female; Humans; Infant; Male; Metrizamide; Organotechnetium Compounds; Pentetic Acid; Pneumoencephalography; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed

Demonstration of the exact site of dural fistulas in cases of cerebrospinal fluid rhinorrhea is difficult. Previous reports have described the use of metrizamide cisternography combined with either hypocycloidal tomography or computerized tomography; however, direct, dynamic, real-time visualization of the fistula is difficult with instillation of a minimal dose of metrizamide using those methods. A digital video subtraction fluoroscopy system can visualize the actual site of the fistula directly and dynamically using only a small amount of metrizamide.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Dura Mater; Fistula; Fluoroscopy; Humans; Male; Metrizamide; Middle Aged; Myelography; Paranasal Sinus Diseases; Radionuclide Imaging; Subtraction Technique; Tomography, X-Ray Computed

Four out of 12 patients with CT-cisternography were operated on. The CT findings were all confirmed at operation. In three patients with positive CT findings, the fistula was located at operation. In one case with negative CT findings, operation revealed no fistula either. Advantages of CT-cisternography are reliability of positive findings and the possibility of locating the fistula in some cases. The procedure bears relatively little risk and can be repeated.

Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Metrizamide; Myelography; Tomography, X-Ray Computed

Demonstration of the exact site of the dural fistula in cerebrospinal fluid rhinorrhea is difficult. Previous reports present the methods of metrizamide cisternography combined with both hypocycloid tomography and computed tomography. But in these methods, direct, dynamic, actual and real-time visualization of the fistula with minimal dose of metrizamide is rather difficult. By using digital video subtraction system (Philips DVI-2CV), we could visualize the direct, dynamic and actual site of fistula with small amount of metrizamide instilled into the suboccipital subarachnoid space with the patient prone position. We report a successful case of traumatic cerebrospinal fluid rhinorrhea drained through the bony defect at the planum sphenoid into the posterior ethmoid sinus. This is the first report to deal with the usefulness of digital video subtraction system for exact localization of cerebrospinal fluid rhinorrhea. We emphasize the usefulness of metrizamide cisternography by the digital video subtraction system combined with the metrizamide computed tomographic cisternography for the precise localization of dural fistula.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Dura Mater; Fistula; Frontal Bone; Humans; Male; Metrizamide; Pneumoencephalography; Radiographic Image Enhancement; Skull Fractures; Subtraction Technique; Tomography, X-Ray Computed

Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted the utility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.

Topics: Aged; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Metrizamide; Myelography; Sphenoid Sinus; Tomography, X-Ray Computed

We performed 32 overpressure radionuclide cisternography (ORNC) studies to examine 26 patients who were clinically suspected of having cerebrospinal fluid (CSF) fistula with rhinorrhea. Fifteen (47%) of these cisternography studies were positive, and the site of the leak was identified. No leak could be demonstrated in the other 17. Of 23 examinations performed in patients who had clinically documented CSF rhinorrhea, 15 (65%) were scintigraphically positive. The rapid cephalad transit of the radionuclide bolus allowed completion of the study within 30 to 45 minutes. Seven examinations were also performed with overpressure metrizamide CT cisternography (OMCTC), and five demonstrated concordant results with the radionuclide study. Patient discomfort and side effects were minimal. We conclude that radionuclide infusion cisternography is a safe, rapid, and accurate method of investigating a suspected or proven CSF rhinorrhea and that it is complementary to metrizamide cisternography.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Cisterna Magna; Female; Fistula; Humans; Intracranial Pressure; Male; Methods; Metrizamide; Middle Aged; Pentetic Acid; Technetium; Technetium Tc 99m Pentetate; Tomography, Emission-Computed

Seven interesting and instructive cases of cerebrospinal fluid rhinorrhea evaluated by metrizamide computed tomographic cisternography are presented. The rhinorrhea was spontaneous in three patients and was related to previous head trauma or surgical procedures in four patients. The anatomical site and the extent of the fistula were demonstrated precisely by directly showing metrizamide passing through the bony defect. A combination of bone dehiscence and metrizamide within the adjacent paranasal sinuses or the nasal cavity is also useful in localization. Distortion of the interhemispheric fissure, sylvian fissure, or basal sulci indicates the probability of brain herniation through the defect.

Topics: Adolescent; Adult; Cerebrospinal Fluid Rhinorrhea; Craniocerebral Trauma; Ethmoid Bone; Female; Fistula; Humans; Male; Meningocele; Metrizamide; Middle Aged; Postoperative Complications; Tomography, X-Ray Computed; Wounds, Penetrating

Topics: Aged; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Metrizamide; Tomography, X-Ray Computed

Cerebrospinal fluid dynamics in a case of traumatic intracerebral pneumocephalus are evaluated with metrizamide computed tomographic cisternography. Accumulation of metrizamide into the air cyst through the ventricular system is due to transependymal penetration, which can be explained by the mechanism of the pressure gradient from the ventricle towards the air cyst.

Topics: Adolescent; Brain; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Humans; Male; Metrizamide; Pneumocephalus; Time Factors; Tomography, X-Ray Computed; Wounds and Injuries

Metrizamide is a water-soluble contrast medium used as a diagnostic tool in myelography and cisternography. Despite its accepted safety, its use has been associated with generalized motor seizures, and several cases of this toxicity have been reported. Risk factors include phenothiazine ingestion, seizure history, and large doses of the contrast material. Abnormal electroencephalographic wave patterns, as well as seizure activity, are less frequent after cisternography than myelography. A case of a metrizamide-induced generalized motor seizure following cisternography is reported in a patient with none of the above risk factors. The need for a thorough medication history and the use of prophylactic anticonvulsants in selected patients is discussed.

Topics: Cerebrospinal Fluid Rhinorrhea; Electroencephalography; Epilepsy, Tonic-Clonic; Female; Humans; Metrizamide; Middle Aged; Myelography; Risk; Seizures

Post-traumatic CSF fistulae and those affiliated with tumours on the skull base have so far been investigated by isotope cisternography, fluoresceine tests and polytomography. 12 patients have recently been studied by metrizamide CT cisternography. In acute post-traumatic cases difficulties arise in the differentiation between blood clots and the stream of contrast medium. The method was found to be useful in delayed CSF fistulae and tumour-associated cases.

Topics: Brain; Cerebrospinal Fluid Rhinorrhea; Humans; Metrizamide; Paranasal Sinuses; Tomography, X-Ray Computed

Topics: Cerebrospinal Fluid Otorrhea; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Empty Sella Syndrome; Humans; Injections, Spinal; Intracranial Pressure; Male; Meningomyelocele; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Metrizamide computed tomographic cisternography was used to examine 27 patients (19 males and eight females, 14-59 years old) clinically suspected of having cerebrospinal fluid fistulae with rhinorrhea. Twenty-one fistulae were traumatic and six were spontaneous. Five to 6 ml of metrizamide (or lopamidol, two cases) were injected by lumbar puncture at a concentration of 185-200 mg I/ml for direct coronal and axial computed tomographic sections of the skull base. Cerebrospinal fluid rhinorrhea was present at the time of examination in 12 of 27 cases. Results were evaluated according to three criteria: (1) metrizamide passage through the bony and dural defect; (2) demonstrable site of the fracture and/or bony defect; and (3) metrizamide visualized within a paranasal sinus, nasal cavity, or cotton pledget. The examination was considered positive when criterion 1 alone was present and when 2 and 3 were associated. In 15 of 27 cases, cisternography was positive, with the exact site of cerebrospinal fluid leakage demonstrated in 10 patients. In six cases, the results were not definitive; only one of the criteria (2 or 3) was fulfilled. In six cases, cisternography was normal. Seventeen patients underwent surgery. The site of cerebrospinal fistulae was ethmoidal in nine cases, frontoethmoidal in seven, sphenoidal in two, and sphenoethmoidal in one. The relative value of metrizamide computed tomographic cisternography compared with other diagnostic studies, polytomography, positive or negative contrast studies, and radionuclides, is discussed. Diagnostic pitfalls include artifacts and partial volume effect.

Topics: Adolescent; Adult; Cerebrospinal Fluid Rhinorrhea; Craniocerebral Trauma; Female; Humans; Male; Metrizamide; Middle Aged; Pneumoencephalography; Tomography, X-Ray Computed

Cerebrospinal fluid (CSF) rhinorrhea is a serious condition which if untreated may lead to meningitis. Detection of the leak site at surgery may be difficult without prior accurate radiological localization of the leak and at times repeat operation has been required. Clinical and radiological localization of the leak is not always easy and many different tests have been tried. Prior to computed tomography (CT), the most common combination of radiological tests were plain films and tomograms of the skull and CSF isotope studies. Although CT scanning may be helpful in assessing a patient with CSF rhinorrhea, it is most effective when combined with intrathecal Metrizamide. The combination of Metrizamide and CT was first reported in 1977 and several case reports and small series of cases have since been reported. The purpose of this article is to review the value of CT especially when used in combination with Metrizamide in the patient with CSF leak and also to discuss the technique of the combined study and to show its value with illustrative cases.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Male; Metrizamide; Middle Aged; Skull Fractures; Sphenoid Bone; Tomography, X-Ray Computed

The radiological appearances of the trigeminal cistern on metrizamide cisternography and metrizamide CT cisternography are described. The frequent demonstration of this cistern on metrizamide cisternography is emphasised. A case of nontraumatic CSF rhinorrhoea produced by a CSF leak between the trigeminal cistern and the sphenoid sinus is described.

Topics: Aged; Cerebrospinal Fluid Rhinorrhea; Cranial Sinuses; Female; Fistula; Humans; Metrizamide; Myelography; Trigeminal Nuclei

Metrizamide computed tomography cisternography was performed for the diagnosis and accurate localization of cerebrospinal fluid (CSF) rhinorrhea in six patients (five posttraumatic and one spontaneous). The examination not only delineated the fracture or bony defect through the base of the skull, but it also demonstrated the leakage of CSF mixed with metrizamide.

Topics: Adult; Aged; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Skull Fractures; Tomography, X-Ray Computed

A case of cerebrospinal fluid rhinorrhea is presented in which routine diagnostic evaluation failed to disclose the site of leakage. Computerized tomography (CT) scanning with metrizamide, a nonionic contrast medium, provided not only documentation of the leak but also demonstrated the actual sinus involved. Metrizamide cisternography with CT scanning is a valuable technique in the evaluation of CSF rhinorrhea. It may only be used when an active leak is present. The patient described in this report lost several drops of CSF from the nose per minute in the face-down position. Neurotoxicity may be avoided by routine pre-examination medication with valium or phenobarbital. Mixing of the contrast agent with CSF is diminished by injecting in the subarachnoid space at C1-C2. The methods used in this examination and their indications are described, and the literature concerning metrizamide toxicity and pharmacologic properties reviewed.

Topics: Cerebrospinal Fluid Rhinorrhea; Humans; Male; Metrizamide; Middle Aged; Myelography; Skull Fractures; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed

A 63-year-old woman with a 10-year history of intermittent cerebrospinal fluid (CSF) rhinorrhea was found to have a transclival meningocele. After pluridirectional tomography demonstrated a bone defect in the clivus, the diagnosis was established by means of computerized tomography (CT) by comparing the absorption coefficients of a soft-tissue mass within the sphenoid sinus before and after the injection of metrizamide into the lumbar subarachnoid space. An increase of 39 absorption units clearly indicated the movement of CSF from the prepontine subarachnoid space into the sphenoid sinus. This case illustrates the value of metrizamide CT cisternography in the evaluation of patients with CSF rhinorrhea.

Topics: Cerebrospinal Fluid Rhinorrhea; Female; Humans; Meningocele; Metrizamide; Middle Aged; Myelography; Skull; Tomography, X-Ray Computed

Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single procedure. Clinical evaluation has disclosed no renewed leakage during a follow-up period from 6 to 18 months.

Topics: Cerebrospinal Fluid Rhinorrhea; Ethmoid Sinus; Female; Follow-Up Studies; Humans; Male; Metrizamide; Middle Aged; Myelography; Paranasal Sinus Diseases; Sphenoid Sinus; Tomography, X-Ray Computed

Metrizamide (Amipaque) is a new water-soluble contrast agent for use in the intrathecal space. Extensive animal and clinical studies have demonstrated its low toxicity. The advantages to the use of metrizamide include the fact that it is miscible with cerebrospinal fluid and can fill narrow spaces, is sufficiently radiopaque to outline delicate structures within the central nervous system, is completely resorbed from the subarachnoid space, and, to date, has not been implicated in the formation of adhesive arachnoiditis. Application of metrizamide to the evaluation of neurologically diseased patients has included myelography, intracranial cisternography, and ventriculography, as well as various techniques in conjunction with computerized tomography. These various uses of metrizamide are discussed together with some indications and advantages. Metrizamide has now replaced Pantopaque and gas as the most commonly used intrathecal contrast agent at the University of Texas Health Science Center at Dallas.

Topics: Adult; Brain; Central Nervous System; Central Nervous System Diseases; Cerebral Ventriculography; Cerebrospinal Fluid Rhinorrhea; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Metrizamide; Myelography; Pneumoencephalography; Tomography, X-Ray Computed

Demonstration of the exact site of the dural fistulae in cerebrospinal fluid rhinorrhea is difficult. This paper presents a technique for accurate localization of these fistulae, using metrizamide cisternography combined with both hypocycloidal tomography and computed tomography.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Dura Mater; Female; Fistula; Humans; Metrizamide; Tomography, X-Ray; Tomography, X-Ray Computed

The subarachnoid space continues into the orbit as part of the optic nerve sheath. This space varies in size but is usually tiny. Occasionally, prominent (one case in our experience) enhancement of the optic nerve as part of metrizamide computed tomography (CT) cisternography is seen on transverse and coronal scans presumably because of a patulous optic subarachnoid space. In five cases, we have appreciated minimal enhancement of optic nerves with metrizamide only by close comparison of CT numbers with base-line scans. One of these patients had a tiny meningioma removed successfully from the optic sheath, with return to normal vision of a previously blind eye.

Topics: Adult; Cerebrospinal Fluid Rhinorrhea; Cranial Nerve Neoplasms; Female; Humans; Injections, Spinal; Meningioma; Metrizamide; Middle Aged; Optic Nerve; Optic Nerve Diseases; Radiographic Image Enhancement; Tomography, X-Ray Computed

The techniques of Amipaque (metrizamide) computerized tomography (CT) cisternography and Amipaque CT ventriculography are described. Normal, intermediate, delayed, and obstructive cerebrospinal fluid circulation patterns are readily demonstrated by evaluation of ventricular stasis of Amipaque on serial CT scans. Both the morphological and physiological characteristics of intracranial cysts are accurately defined and a diagnostic classification is presented. The functional integrity of ventricular shunts can be appraised using the ventricular persistance of Amipaque as a primary criterion. Other applications of these modalities are described and their place in the neurodiagnostic armamentarium is discussed.

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Cysts; Humans; Hydrocephalus; Infant; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Cerebrospinal Fluid Rhinorrhea; Cisterna Magna; Humans; Male; Metrizamide; Middle Aged; Tomography, X-Ray Computed

Topics: Cerebrospinal Fluid Rhinorrhea; Cisterna Magna; Female; Humans; Iodobenzoates; Metrizamide; Middle Aged; Tomography, X-Ray Computed