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Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

Published online by Cambridge University Press:  10 May 2021

T Hendriks ,
A Thompson ,
R Boeddinghaus ,
H E I Tan  and
J Kuthubutheen
T Hendriks*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Australia Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia School of Surgery, University of Western Australia, Nedlands, Australia
A Thompson
Affiliation:
Perth Radiological Clinic, Subiaco, Australia
R Boeddinghaus
Affiliation:
Perth Radiological Clinic, Subiaco, Australia Department of Surgery, University of Western Australia, Nedlands, Australia
H E I Tan
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia Radiology, Sir Charles Gairdner Hospital, Nedlands, Australia
J Kuthubutheen
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Australia Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia School of Surgery, University of Western Australia, Nedlands, Australia
*
Author for correspondence: Dr Thomas Hendriks, Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch6150, WA, Australia E-mail: thomas.hendriks@health.wa.gov.au. Fax: +61 08 6457 4899
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Abstract

Background and objective

Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak.

Methods

A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed.

Results

Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm).

Conclusion

Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

Keywords

Cerebrospinal Fluid Otorrhea, SpontaneousSkull BaseNeuro-OtologyTemporal BoneBrain Imaging
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 5 , May 2021 , pp. 403 - 409
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr T Hendriks takes responsibility for the integrity of the content of the paper

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