Imaging of skull base cerebrospinal fluid leaks in adults

http://www.ncbi.nlm.nih.gov/pubmed/18710972

Cerebrospinal fluid (CSF) leak occurs when there is an osseous and dural defect at the skull base, with direct communication of the subarachnoid space to the extracranial space, usually a paranasal sinus. Recognition of the leak site and source and appropriate treatment are necessary to avoid rhinorrhea or otorrhea, low-pressure headaches, and meningitis, known complications of CSF leak. The imaging evaluation has evolved over the past several decades. Description of current techniques available to direct treatment options, including multidetector thin-section computed tomography, and imaging recommendations are presented.

http://www.ncbi.nlm.nih.gov/pubmed/18079188

CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings.

http://www.ncbi.nlm.nih.gov/pubmed/18079188

BACKGROUND AND PURPOSE:

Skull base defects can result in CSF leaks, with meningitis as a potential complication. Surgeons are now routinely repairing these leaks via a nasal endoscopic approach. Accurate preoperative imaging is essential for surgical planning. A variety of imaging regimens have been employed, including axial and direct coronal CT, CT cisternography with iodinated contrast, radionuclide cisternography, and MR imaging. Now that multidetector helical CT is available, the purpose of this study was to determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks.

One Year and Counting!

It has been one year since my craniotomy to repair four skull leaks. 

I am still not leaking, which based on what I know now, is practically a miracle.  I have found a support group of leakers on Facebook who have taught me a lot...mostly that I am very lucky and blessed.

I have not spoken this to anyone, nor have I written it, but even though I am healed, I am still scared.  Scared that I will start leaking again and my world will be turned upside down.  My ear hurts almost constantly (the side of the craniotomy and also the ear tube surgery.)  I am always worried that I might have an ear infection...which could mean the leaking has started again.  (My doctor confirms I don't!)

When I get a headache, I wonder if it will be THE BIG ONE...and a sign of another leak.  When I bend over to dry my hair, and stand back up, I wonder...will CSF pour out of my nose this time??  When I get a massage, and they work on my scalp, I am afraid they will disrupt the surgery and cause me to leak again. 

All probably irrational thoughts...but I have seen what this disease does to people and I don't ever want to go through it again.  I was lucky the first time because I was diagnosed and treated so quickly.  My FB friends are not so lucky and I wonder how/why my experience was so different. 

Mostly, I wish there was something I could do for the others who suffer from CSF leaks.  Even though I don't know any of them personally, I feel connected to all of them.  I hope my story gives them hope. 

I know I can't control whatever happens to me now...and if I leak again, I will just have to deal with it.  I feel so guilty for my cure when so many others are suffering beyond belief.  Guilty but thankful.  And scared...always scared.  Maybe one day I will be able to put this behind me and get past the fear.  That is my hope for myself. 

My hope for others suffering with a leak is that they will find a knowledgeable and compassionate doctor who will care enough about them to help them find a cure.  And for those still searching, I wish them the ability to HANG ON as long as it takes.