Usefulness of Intrathecal Gadolinium Enhanced Magnetic Resonance Cisternography in Cerebrospinal Fluid Fistula: Case Report

ABSTRACT

Accurate localization of cerebrospinal fluid(CSF) fistulae makes the planning of surgery easier, increases the chances of successful dural repair and eliminates negative exploration. The authors report our early experience with intrathecal use of gadolinium DTPA(Gd-DTPA) magnetic resonance(MR) cisternography for evaluation of CSF leakage and localization. By means of lumbar puncture, a single dose of 1ml of gadolinium DTPA mixed with 4ml NaCl 5% was injected. The images were interpreted by comparing those before and after injection. Three patients showed leakage of contrast material through the cribriform plate into the ethmoid or sphenoid air cells. No leakage was observed in one patient. The study results show the relatively safety and feasibility of low-dose Gd-DTPA MR cisternography in confirming the presence and determining the focus of active CSF leaks.