Submillimeter CT missed only 1 CSF leak, which was the 3-mm cribriform defect in patient 12 mentioned previously. Depiction of fine bony detail is clearly sharper with 0.625-mm collimation.

The width of the cribriform plate was (2.81±0.47)mm, and no statistical difference was found between age groups (F=1.25, P=0.24).

Our anatomical study demonstrates the existence of both foramina.

CONCLUSION: Axial images, and coronal, sagittal, and oblique MPR images generated from high-resolution axial CT performed well preoperatively, localizing the skull base defect responsible for the CSF leak.

The use of cisternography, however, is surgeon dependent because experienced endoscopists can usually determine at the time of surgery if a defect is leaking. Another important finding was that the accuracy of noncontrast CT was equally good in active and inactive CSF leaks. To read the article of this research, you can request a copy directly from the authors.

The preoperative CT directed the initial intraoperative endoscopic examination, but the skull base was carefully examined around the suspected leak site.

Um jedoch ein sicheres Vorgehen gewährleisten zu können, ist das exakte Wissen der anatomischen Verhältnisse, insbesondere der Siebbeindachkonfiguration eine absolute Notwendigkeit.

As defined by opacity abutting the undersurface of the cribriform plate, the prevalence of olfactory recess opacity (ORO) on sinus CT was examined to clarify whether this should raise suspicion for an unsuspected pathologic process. Visual grading characteristic analysis showed significantly better image quality ratings for the CISS sequence compared to the 3D-T2w and 2D-T2w sequence, and the 2D-T2w sequence performed significantly better compared to the 3D-T2w sequence (P < .001). The third lesion could not be identified on CT even after the intraoperative findings were reported. It is perhaps more important to note that our series is the first, to our knowledge, to evaluate how accurately CT measurements compare with intraoperative sizes of the responsible skull base defects. The olfactory cleft has garnered interest since the advent of endoscopic skull base surgery. Es wurden im vorderen, mittleren und hinteren Siebbeinabschnitt sowohl die Tiefe als auch die Breite der Fossa olfactoria ebenso gemessen wie die Höhe der Sinus ethmoidales und altersrelevante Charakteristika dokumentiert.

The 8 spontaneous CSF leaks confirmed at endoscopy were distributed among the ethmoid roof (1/8), sphenoid (2/8), cribriform (3/8), and posterior wall of the frontal sinus (2/8).

CT was considered accurate if it correctly localized the CSF leak and was within 2 mm of the endoscopic measurement. CSF leaks may also arise spontaneously, especially in the setting of idiopathic intracranial hypertension. In the subgroup of 21 patients who had surgical corroboration, the sensitivity of noncontrast high-resolution CT was 100% compared with 76% for radionuclide cisternography and 48% for CT cisternography.

The CISS sequence yielded the highest concordance correlation coefficient (0.84), precision (0.85), and accuracy (0.99). Thank you for your interest in spreading the word on American Journal of Neuroradiology. Radiographic Techniques of the Nasal Cavity and Sinuses.

Therefore, endoscopy identified only 2 small CSF leaks that were missed by CT, a 3-mm right cribriform plate defect (patient 12, Fig 3), and a 2-mm sphenoid defect (patient 10). A prospective study of 150 CT scans showed that the right ethmoidal roof was lower than the left in 8.6 per cent of cases.

One hundred sides of 50 paranasal coronal CT images in patients with sinusitis were analyzed to assess the location of the AEC, the shape of the superolateral wall of the ethmoid sinus anterior and posterior to the AEC, and pneumatization of the roof of the anterior ethmoid sinus.
In the remaining 2 (18%) of 11 cases, CT minimally overestimated the size of the osseous defect by only 3 mm. Vertically oblique views separated both structures to produce two lines. Skull base defects that result in dural tears and CSF leaks can be associated with significant long-term disability, primarily related to central nervous system infection. Further data were supplemented by examinations of 62 patients affected by nonneoplastic disease of the paranasal sinuses.

These sella-related patterns do not take into account the sagittal position of the ethmoidal spine (process) and the inconstant alae minimae of Luschka that project anteriorly from the jugum sphenoidale towards the ethmoidal sieve-plate (lamina cribriformis), ... La desviación del septo nasal es considerada también una variante anatómica de la región etmoidal, la cual adquiere relevancia quirúrgica cuando produce obstrucción al pasaje de aire por una o por las dos fosas nasales, o cuando causa obstrucción al drenaje de los senos que desembocan en el meato medio, produciendo una acumulación de secreciones y la consiguiente infección(27)(28)(29).En la literatura se encuentran descritas variantes anatómicas que tienen menos relevancia clínico-quirúrgica, como son la neumatización del apófisis crista galli, cornetes supernumerarios, cornete superior bulloso o paradojal, cornete supremo y la neumatización del tabique nasal, ya sea en la porción de la lamina perpendicular del etmoides, como en el vómer (1, 7, 36).La arteria etmoidal anterior, en su trayecto por el laberinto etmoidal, adquiere relevancia dentro de las variantes anatómicas, puesto que depende de la profundidad del techo etmoidal, para poder identificarla sin lesionarla en el transcurso de las cirugías endoscópicas naso-sinusales.
MATERIALS AND METHODS: We retrospectively reviewed imaging findings and surgical records of 19 patients who presented to our tertiary care institution during a 2.5-year period with clinically proved CSF leak. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT).

However, MR cisternography does not provide the fine bony detail necessary for planning minimally invasive endoscopic repair.

Die Breite beträgt links wie rechts im Mittel 6,8 mm.

Stone et al8 directly compared noncontrast high-resolution CT with radionuclide cisternography and CT cisternography in 42 patients with CSF leaks.8 The sensitivity of noncontrast high-resolution CT was greater than that of radionuclide cisternography and CT cisternography. This study employed both sagittal computed tomography and cadaver dissection.

The variations important in anterior skull base approaches are also discussed and compared with the data found in the literature.

The height of heights of lateral plate sieve was greater in left than in right (t=4.70, P<0.001), no statistical gender difference was found both for the left and right heights of lateral plate sieve (t=1.32, 1.51, P=0.17, 0.13), and no statistical gender difference was found both for the left and right angulations of lateral plate sieve (t=0.78, 1.03, P=0.43, 0.30). The aim of this study was to compare different sequences for olfactory bulb volumetry using 3-T magnetic resonance imaging, evaluating reproducibility, repeatability, and systematic biases.

Endoscopy identified 22 CSF leaks in 18 of 19 patients.

Forty anterior ethmoidal arteries were anatomically prepared.

This finding could account for the higher reported incidence of endocranial complications associated with right ethmoidectomy. Use the link below to share a full-text version of this article with your friends and colleagues. Conclusions: The relative performance of sequences was assessed using visual grading characteristic analysis. A previous study by the author on the incidence of complications of sinusectomy revealed that injuries to the base of the skull occurred in 0.15% and acute meningitis in 0.01% in a total of 450,000 sinus operations performed in Japan. Bony dehiscences could be demonstrated in 12% of the cases. The CT images were interpreted without knowledge of the intraoperative findings; specifically, neither the presence, site, nor size of the leak was known at the time of image review.

To contribute to a better understanding of the prognostic differences between atypical and malignant meningiomas as defined by the World Health Organization (WHO) and the influence of the grade of initial surgical excision on postoperative course, 42 cases of atypical and 29 of malignant meningioma were studied, along with long-term follow up. 41 Kinder (15 %) zeigten eine Asymmetrie der Foveae ethmoidales.


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