MR findings suggestive of idiopathic intracranial hypertension in 117 patients with spontaneous cerebrospinal fluid rhinorrhea.
CSF rhinorrhea
Diagnostic criteria
Empty sella
Intracranial hypertension
Magnetic resonance imaging
Journal
Neuroradiology
ISSN: 1432-1920
Titre abrégé: Neuroradiology
Pays: Germany
ID NLM: 1302751
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
13
08
2021
accepted:
15
10
2021
pubmed:
23
10
2021
medline:
15
4
2022
entrez:
22
10
2021
Statut:
ppublish
Résumé
The purpose of this study is to document the prevalence of MR findings suggestive of idiopathic intracranial hypertension (IIH) in patients undergoing endoscopic repair of spontaneous CSF rhinorrhea (SCSFR). In a retrospective study, MR images of 117 consecutive patients who had undergone endoscopic repair of SCSFR were evaluated for features suggestive of IIH (empty sella, widened optic nerve sheath, tortuous optic nerve, flattened posterior globe, and enlarged Meckel's cave). Pituitary height was used to diagnose partial and complete empty sella. MR images were independently evaluated by two of the authors without knowledge of the clinical findings. Consensus method was used to resolve differences between the two evaluators. Empty or partially empty sella was diagnosed in the MR of 105 (89.7%) patients. In 38/105 (36.2%) patients with empty/partial empty sella, no additional MR findings were present. In 43/105 (41%) patients, one or more of the MR features with high specificity for diagnosis of IIH (flattened posterior globe and enlarged Meckel's cave) were seen. In the other 24 (22.9%) additional MR findings, less specific for IIH (widened optic nerve sheath, tortuous optic nerve) were noted. Papilledema was seen in 11 of 60 (18.3%) patients who underwent funduscopic examination. All patients with papilledema had empty/partial empty sella, and 9/11 (81.8%) had an additional MR finding suggestive of IIH. The majority of patients with SCSFR have MR imaging features of IIH. These imaging features should be a major component of previously published modified diagnostic criteria for IIH in patients with SCSFR.
Identifiants
pubmed: 34677642
doi: 10.1007/s00234-021-02840-6
pii: 10.1007/s00234-021-02840-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
949-958Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE (2006) Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 115(7):495–500
doi: 10.1177/000348940611500703
Yang Z, Wang B, Wang C, Liu P (2011) Primary spontaneous cerebrospinal fluid rhinorrhea: a symptom of idiopathic intracranial hypertension? J Neurosurg 115(1):165–170
doi: 10.3171/2011.3.JNS101447
Banks CA, Palmer JN, Chiu AG, O’Malley BW, Woodworth BA, Kennedy DW (2009) Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 140:826–833
doi: 10.1016/j.otohns.2008.12.060
Schlosser RJ, Maloney-Wilensky E, Grady MS, Palmer JN, Kennedy DW, Bolger WE (2004) Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 130:443–448
doi: 10.1016/j.otohns.2003.12.018
Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81(13):1159–1165
doi: 10.1212/WNL.0b013e3182a55f17
Aaron G, Doyle J, Vaphiades MS, Riley KO, Woodworth BA (2014) Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema. Otolaryngol Head Neck Surg 151:1061–1066
doi: 10.1177/0194599814551122
Quatre R, Attye A, Righini CA, Reyt E, Giai J, Schmerber S, Karkas A (2017) Spontaneous cerebrospinal fluid rhinorrhea: association with bodyweight and imaging data. J Neurol Surg B 78:419–424
Bialer OY, Rueda MP, Bruce BB, Newman NJ, Biousse V, Saindane AM (2014) Meningoceles in idiopathic intracranial hypertension. Am J Roentgenol 202(3):608–613
doi: 10.2214/AJR.13.10874
Degnan AJ, Levy LM (2011) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 32(11):1986–1993
doi: 10.3174/ajnr.A2404
Reh DD, Gallia GL, Ramanathan M, Solomon D, Moghekar A, Ishii M, Lane AP (2010) Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks: presentation of a novel technique. Am J Rhinol Allergy 24:238–243
doi: 10.2500/ajra.2010.24.3465
Kenning TJ, Willcox TO, Artz GJ, Schiffmacher P, Farrell CJ, Evans JJ (2012) Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes. Neurosurg Focus 32:E6
doi: 10.3171/2012.4.FOCUS1265
Chaaban MR, Illing E, Riley KO, Woodworth BA (2014) Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope 124:70–75
doi: 10.1002/lary.24160
Martínez-Capoccioni G, Serramito-García R, Martín-Bailón M, García-Allut A, Martín-Martín C (2017) Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension. Eur Arch Otorhinolaryngol 274:2175–2181
doi: 10.1007/s00405-017-4455-5
Silver RI, Moonis G, Schlosser RJ, Bolger WE, Loevner LA (2007) Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: a possible presentation of idiopathic intracranial hypertension. Am J Rhinol 21:257–261
doi: 10.2500/ajr.2007.21.3026
Quatre R, Attye A, Righini C, Reyt E, Giai J, Schmerber S, Karkas A (2017) Spontaneous cerebrospinal fluid rhinorrhea: association with body weight and imaging data. J Neurol Surg B Skull Base 78:419–424
doi: 10.1055/s-0037-1603731
Jiang ZY, McLean C, Perez C, Barnett S, Friedman D, Tajudeen BA, Batra PS (2018) Surgical outcomes and postoperative management in spontaneous cerebrospinal fluid rhinorrhea. J Neurol Surg B Skull Base 79(2):193–199
doi: 10.1055/s-0037-1606306
Bidot S, Levy JM, Saindane AM, Narayana KM, Dattilo M, Del Gaudio JM, Mattox DE, Oyesiku NM, Peragallo JH, Solares CA, Vivas EX, Wise SK, Newman NJ, Biousse V (2021) Spontaneous skull base cerebrospinal fluid leaks and their relationship to idiopathic intracranial hypertension. Am J Rhinol Allergy 35(1):36–43
doi: 10.1177/1945892420932490
Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson D (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527
doi: 10.1007/s00234-006-0095-y
Kwee RM, Kwee TC (2019) Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension. Eur J Radiol 116:106–115
doi: 10.1016/j.ejrad.2019.04.023
Yuh WTC, Zhu M, Taoka T, Quets JP, Maley JE, Muhonen MG, Schuster ME, Kardon RH (2000) MR Imaging of pituitary morphology in idiopathic intracranial hypertension. J Magnet Res Imag 12:808–813
doi: 10.1002/1522-2586(200012)12:6<808::AID-JMRI3>3.0.CO;2-N
Brodsky CM, Vaphiades M (1998) Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology 105:1686–1693
doi: 10.1016/S0161-6420(98)99039-X
Morris PP, Black DF, Port J, Campeau N (2017) Transverse sinus stenosis is the most sensitive MR imaging correlate of idiopathic intracranial hypertension, AJNR Am. J Neuroradiol 38:471–477
doi: 10.3174/ajnr.A5055
Delen F, Peker E, Onay M, Altay CM, Tekeli O, Işıkay CT (2018) The significance and reliability of imaging findings in pseudotumor cerebri. Neuroophthalmology 43:81–90
doi: 10.1080/01658107.2018.1493514
Butros SR, Goncalves LF, Thompson D, Agarwal A, Lee HK (2012) Imaging features of idiopathic intracranial hypertension, including a new finding: widening of the foramen ovale. Acta Radiol 53:682–688
doi: 10.1258/ar.2012.110705
Bidot S, Levy JM, Saindane AM, Oyesiku NM, Newman NJ, Biousse V (2019) Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension? J Neuroophthalmol 39:487–495
doi: 10.1097/WNO.0000000000000761
Foresti M, Guidali A, Susanna P (1991) Primary empty sella: incidence in 500 asymptomatic subjects examined with magnetic resonance (Italian). Radiol Med 81:803–808
pubmed: 1857785
Debnath J, Ravikumar R, Sharma V, Senger KPS, Maurya V, Singh G, Sharma P, Khera A, Singh A (2016) ‘Empty sella’ on routine MRI studies: an incidental finding or otherwise? Med J Armed Forces India 72:33–37
doi: 10.1016/j.mjafi.2015.11.012
Fisayo A, Bruce BB, Newman NJ, Biousse V (2016) Overdiagnosis of idiopathic intracranial hypertension. Neurology 86:341–350
doi: 10.1212/WNL.0000000000002318
Teachey W, Grayson J, Cho DY, Riley KO, Woodworth BA (2017) Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks. Laryngoscope 127(9):2011–2016
doi: 10.1002/lary.26612