成人蝶窦自发性脑脊液鼻漏及并存颅内高压的影像表现

Imaging findings of adult sphenoid spontaneous cerebrospinal fluid rhinorrhea and accompanying intracranial hypertension

目的分析成人蝶窦自发性脑脊液鼻漏及并存颅内高压的影像特征。方法回顾性分析30例经手术证实的成人蝶窦自发性脑脊液鼻漏患者的cT与MRI资料。男11例、女19例；年龄31～64岁，平均（50~8）岁；1例仅行CT检查，4例仅行MRI检查，25例同时行cT和MRI检查。影像结果评价指标包括：漏口显示率，漏口部位、大小及数量，窦口邻近结构改变（蝶窦积液及脑膜脑膨出情况），伴随的颅内高压影像征象（蛛网膜颗粒小凹、空蝶鞍及视神经周围蛛网膜下腔增宽），并与手术所见进行比较。结果本组30例中，鼻内镜手术示漏口83％（25／30）位于蝶窦侧隐窝上壁与中颅窝交界处，10％（3／30）位于蝶窦侧隐窝上壁，7％（2／30）位于蝶窦侧壁。cT显示80．7％（21，26）漏口处蝶窦壁骨质缺损，96．1％（25／26）侧隐窝过度气化。MRI显示27．6％（8／29）漏口处线状脑脊液高信号从颅底蛛网膜下腔延续至蝶窦腔；89．6％（26／29）伴脑膜脑膨出，82．7（24／29）窦腔脑脊液高信号充填，27．6％（8／29）窦腔气．液平面，75．9％（22／29）漏口邻近侧裂池扩大，3．4％（1／29）邻近侧脑室颞角扩大，3．4％（1／29）邻近脑沟增宽。本组患者伴颅内高压征象：MRI检查100％（29／29）空蝶鞍，93．1％（27／29）视神经周围蛛网膜下腔增宽，CT、MRI显示100％（30／30）中颅窝底蛛网膜颗粒小凹。结论自发性脑脊液蝶窦漏与颅内高压同时存在；CT和MRI联合应用能准确判定漏口及其伴随的颅内高压征象。

Objective To study the CT and MR imaging feature of adult sphenoid spontaneous cerebrospinal fluid （CSF） rhinorrhea and accompanying intracranial hypertension. Methods Thirty consecutive patients including 11 males and 19 females with mean age of （50＋8） years （range, 31 to 64 years） were retrospectively reviewed. Imaging findings in 30 patients with adult sphenoid spontaneous CSF rhinorrhea （CT in 26 patients, MR in 29 patients, and both CT and MR in 25 patients） were analyzed. The MR imaging and CT features were evaluated by two experienced head and neck radiologists. The CT and MR imaging parameters of 30 fistulas were evaluated, including side, location, size, amount, bony change, and the adjacent structures change. Results Of the 30 patients of adult sphenoid spontaneous CSF rhinorrhea lesions, the site of the CSF fistula confirmed by endoscopy surgery was at the junction of the roof of the inferolateral recess and the floor of the middle cranial in 25 （83%, 25/30） patients, the roof of the inferolateral recess in 3 （10%,3/30） patients, and the lateral wall of the sphenoid sinus in 2 （7%,2/30）. CT images revealed the osseous defects of the sphenoid sinus walls in 21 patients （80.7%, 21/26） patients, excessive pneumatization of the inferolateral recess of the sphenoid sinuses in 25 cases （96.1%, 25/26）. MRI demonstrated the linear hyperintensity communicating subarachnoid space and sphenoid cavity, accompanying meningoencephalocele in 26 （89.6%, 26/29） patients, sphenoid sinus filled with CSF in 24 （82.7% ,24/29） patients and air-fluid level in the sphenoid sinus in 8 cases （27.6%, 8/29）, excessive expansion of adjoining lateral fissure cistern in 22 cases （75.9%,22/29）, adjoining sulcus in one case （3.4%,1/29）, adjoining lateral ventricle in one case （3.4%,1/29）. The imaging feature of accompanying intracranial hypertension included empty sella in 29 cases （100%, 29/29）, augmentation of the complex of the optic sheath in 27 cases （93.1%, 27/29）, the araehnoid pits in the middle cranial fossa in 30 cases （100%）. Conclusions The spontaneous CSF fistula coexists with intracranial hypertension. The combined application of CT and MRI can accurately identify the fistula with accompanying symptom and the intraeranial hypertension.