[MR findings in traumatic cerebrospinal fluid leakage with special reference to indications of the need for dural repair].

Eleven cases of traumatic cerebrospinal fluid (CSF) leakage (8 cases of rhinorrhea and 3 cases of otorrhea) were reviewed to discuss magnetic resonance (MR) findings and surgical indications of the need for dural repair. Five patients had delayed onset of CSF rhinorrhea, 12 to 66 days (mean 28 days) after the trauma, and in the remaining 6 patients (3 rhinorrhea and 3 otorrhea) CSF leakage was noted on admission. MR study was carried out within 7 days after the onset of CSF leakage using a 0.5 tesla imager. In 7 cases of rhinorrhea, MR images demonstrated brain herniation into the ethmoid or frontal sinuses and the dural defects were repaired with the vascularized periosteum flap taken from the frontal bone or the fascia lata. In the operations, brain parenchyma was found to be plugged into the fracture line as MR images showed, and also to adhere to the margin of dural fistula. In the remaining 4 patients (without the MR findings of brain herniation into the paranasal sinuses) spontaneous cessation of CSF leakage occurred and their clinical course was good. Spontaneous cessation of CSF leakage in these cases may suggest the complete healing of the lacerated dura. However, in cases with the brain herniated into the paranasal sinuses CSF leakage may not be observed, and natural healing of the dural defect cannot be expected. Therefore, such brain herniation indicates the absolute need for dural repair even if CSF leakage is not observed.(ABSTRACT TRUNCATED AT 250 WORDS)