CT cisternography role in posttraumatic basal liquorrhea diagnostics
Keywords:traumatic brain injury, basal liquorrhea, nasal liquorrhea, diagnostics, CT cisternography
Inroduction. Posttraumatic basal liquorrhea (PBL) is found in 2–3% of TBI patients. The meningitis occurrence rate in patients with posttraumatic liquor fistulas (PLF) ranges from 3 to 50%. CT cisternography accuracy in PBL diagnostics varies from 22 to 100%.
Methods. 29 patients were studied for the purpose of determining CT cisternography efficacy in PBL diagnostics. A contrast medium, Ultravist-240, in the amount of 0.15 ml per 1 kg of a patient’s mass was infused endolumbally. Frontal CT scanning from posterior border of the petrous part of the temporal bone to anterior frontal sinus wall using General Electric 2-slice spiral computer tomographic scanner, CTe-Dual, was also performed.
Results. The presence of meningoencephalocele and contrasted liquor penetration beyond subarachnoid space was determined using CT cisternography in 28 (96.6%) patients. 25 patients had one PLF, and 4 patients had two PLF. In each case, a surgical intervention confirmed the diagnosis.
Conclusions. CT cisternography is a “gold standard” in PBL diagnostics that makes it possible to correctly localize and quantify PLFs in 96.6% cases. Determining the specificity of liquor leakage allows performing CT cisternography at the moment of the best possible PLF contrast enhancement. Full information about PLF makes it possible to correctly choose necessary access as well as approach to it.
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