Critical basilar expansion of the sphenoidal sinus associated with a spontaneous cerebrospinal fluid fistula: the relevance of multidetector computed tomographic cisternography

Expansão basilar crítica do seio esfenoidal associada à fístula liquórica espontânea: a relevância da cisternotomografia computadorizada multidetectores

IMAGES IN NEUROLOGY

Critical basilar expansion of the sphenoidal sinus associated with a spontaneous cerebrospinal fluid fistula: the relevance of multidetector computed tomographic cisternography

Expansão basilar crítica do seio esfenoidal associada à fístula liquórica espontânea: a relevância da cisternotomografia computadorizada multidetectores

Antônio José da Rocha; Carlos Jorge da Silva

Section of Neuroradiology, Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil

^{Correspondence}

A 46-year-old woman presented with an intermittent nontraumatic cerebrospinal fluid (CSF) left rhinorrhea. A multidetector computed tomographic (MDCT) study was performed to investigate a CSF fistula (Figure).

The sphenoidal sinus is prone to CSF leakage, when anatomical variations occur. The basilar expansion is a posterior expansion of the sphenoidal sinus (postsellar). It is considered critical for endoscopic surgery approach and also a predisposing factor to spontaneous or posttraumatic CSF fistula when the posterior wall of the sphenoidal sinus is <2 mm thick¹.

Similar imaging reports in current literature are rare^1-4. Typical pattern on MDCT images, particularly after iodinated intrathecal contrast administration, reinforces its relevance to confirm the exact location of the CSF fistula for a proper surgical approach.

Received 24 May 2012

Received in final form 20 June 2012

Accepted 27 June 2012

Conflict of interest: There is no conflict of interest to declare.

• 1. Haetinger RG, Navarro JA, Liberti EA. Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study. Eur Radiol 2006;16:2092-2099.
• 2. Lockwood AH, Quencer RM, Page LK. CSF rhinorrhea from a transclival meningocele demonstrated with metrizamide CT cisternography. Case report. Neurosurgery 1980;53:553-555.
• 3. Akyuz M, Arslan G, Gurkanlar D, Tuncer R. CSF rhinorrhea from a transclival meningocele: a case report. Neuroimaging 2008;18:191-193.
• 4. Shetty PG, Shroff MM, Fatterpekar GM, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000;21:337-342.

Publication Dates

• Publication in this collection
  14 Nov 2012
• Date of issue
  Nov 2012