Department of Neurosurgery, Research Institute of Surgery & Daping Hospital, Third Military Medical University, Chongqing, China.
Radiol Oncol. 2011 Jun;45(2):91-6. doi: 10.2478/v10019-011-0007-6. Epub 2011 Mar 15.
Multiple basilar skull fracture and cerebrospinal leak are common complications of traumatic brain injury, which required a surgical repair. But due to the complexity of basilar skull fracture after severe trauma, preoperatively an exact radiological location is always difficult. Multi-row spiral CT and MRI are currently widely applied in the clinical diagnosis. The present study was performed to compare the accuracy of cisternography by multi-row spiral CT and MRI in the diagnosis of cerebrospinal leak.
A total of 23 patients with multiple basilar skull fracture after traumatic brain injury were included. The radiological and surgical data were retrospectively analyzed. 64-row CT (mm/row) scan and three-dimensional reconstruction were performed in 12 patients, while MR plain scan and cisternography were performed in another 11 patients. The location of cerebrospinal leak was diagnosed by 2 experienced physicians majoring neurological radiology. Surgery was performed in all patients. The cerebrospinal leak location was confirmed and repaired during surgery. The result was considered as accurate when cerebrospinal leak was absent after surgery.
According to the surgical exploration, the preoperative diagnosis of the active cerebrospinal leak location was accurate in 9 out of 12 patients with CT scan. The location could not be confirmed by CT because of multiple fractures in 2 patients and the missed diagnosis occurred in 1 patient. The preoperative diagnosis was accurate in 10 out of 11 patients with MRI examination.
MRI cisternography is more advanced than multi-row CT scan in multiple basilar skull fracture. The combination of the two examinations may increase the diagnostic ratio of active cerebrospinal leak.
多发颅底骨折和脑脊液漏是颅脑外伤的常见并发症，需要手术修复。但由于严重创伤后颅底骨折的复杂性，术前很难准确确定放射学位置。多层螺旋 CT 和 MRI 目前广泛应用于临床诊断。本研究旨在比较多层螺旋 CT 和 MRI 脑池造影在诊断脑脊液漏中的准确性。
共纳入 23 例创伤性脑损伤后多发颅底骨折患者。回顾性分析影像学和手术资料。12 例患者行 64 排 CT（mm/排）扫描和三维重建，11 例患者行 MR 平扫和脑池造影。由 2 名神经放射学专业医师诊断脑脊液漏的位置。所有患者均进行手术。术中确认并修复脑脊液漏位置。术后无脑脊液漏时视为准确。
根据手术探查，CT 扫描术前诊断 12 例患者中 9 例有活动性脑脊液漏。2 例患者因多发骨折无法通过 CT 确认，1 例患者漏诊。MRI 检查术前诊断 11 例患者中 10 例准确。
MRI 脑池造影在多发颅底骨折中比多层螺旋 CT 扫描更先进。两种检查的结合可能会增加活动性脑脊液漏的诊断率。
