metrizamide and Craniocerebral-Trauma

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

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

Computer tomography (CT) findings obtained from the first 3,000 scans on 2,031 patients were analyzed and discussions were made on various kinds of neurological diseases, especially from the neurosurgical point of view. CT showed an excellent resolution for three-dimensional morphological pattern of intracranial lesion with a high percentage of diagnostic accuracy as reported from other institutes, resulting in making much earlier morphological diagnosis of intracranial lesion possible than any other examination. Scan methods consisted of plain CT, contrast enhanced CT, and metrizamide CT cisternography. Sequential delayed enhanced CT offered more useful information for high diagnostic accuracy, particularly for nature of brain tumor. Metrizamide CT cisternography was performed for the evaluation of cerebrospinal fluid dynamics and diagnosis of skull base tumors. CT is a new, epoch-making and non-invasive diagnostic approach in neuroradiology and contributes to obtain the better achievement of neurosurgical results.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Cerebrovascular Disorders; Child; Child, Preschool; Contrast Media; Craniocerebral Trauma; Diagnosis, Differential; Female; Head; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Metrizamide; Middle Aged; Radiographic Image Enhancement; Tomography, X-Ray Computed