Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Calle Diego de Velázquez 1, 28223 Pozuelo de Alarcón, Madrid, Spain.
Radiographics. 2013 Mar-Apr;33(2):553-70. doi: 10.1148/rg.332125028.
Cerebrospinal fluid (CSF) fistulas are characterized by the egress of CSF from the intracranial cavity through an osteodural disruption between the subarachnoid space and a pneumatized structure within the skull base. Depending on the cause, CSF fistulas are classified as acquired or congenital, and acquired fistulas are further classified as traumatic, nontraumatic, or spontaneous. Spontaneous CSF fistulas are considered to result from a multifactorial process and have been postulated to represent a variant of idiopathic intracranial hypertension. However, an anatomic predisposition involving thinning of the cranial base, such as pneumatization of the sinus walls, must also be present. This process creates areas of structural weakness that act as potential pathways for CSF leaks, which most commonly occur in the ethmoid roof, sphenoid sinus, and temporal bone. Because CSF leaks may be overlooked, a result of their asymptomatic or subtle, intermittent course, a high level of suspicion is crucial in making an early diagnosis. However, CSF fistulas may be well seen at computed tomography (CT), which depicts bone defects, and magnetic resonance cisternography, which reveals the contents of herniated tissue. Knowledge of the location and size of the bone defect and herniated contents is crucial for the selection of surgical approach and grafting material.
脑脊液（CSF）瘘是指 CSF 通过蛛网膜下腔和颅底含气结构之间的骨-硬脑膜破坏从颅内腔流出。根据病因，CSF 瘘可分为获得性或先天性，获得性瘘进一步分为创伤性、非创伤性或自发性。自发性 CSF 瘘被认为是多因素过程的结果，并被认为是特发性颅内高压的一种变体。然而，也必须存在涉及颅底变薄的解剖倾向，例如鼻窦壁的气化。这个过程会产生结构薄弱的区域，成为 CSF 漏的潜在途径，最常见于筛骨顶部、蝶窦和颞骨。由于 CSF 漏可能被忽视，因为它们无症状或轻微、间歇性，因此高度怀疑对于早期诊断至关重要。然而，CSF 瘘在 CT 上可能很明显，CT 可以显示骨缺损，磁共振脑池造影可以显示疝出组织的内容物。了解骨缺损和疝出内容物的位置和大小对于选择手术入路和移植材料至关重要。
