الفهرس 
INTRODUCTONOnly 14 pages are availabe for public view
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Abstract
High resolution CT is an efficacious, noninvasive method that should be used in the first line of investigation of CSF rhinorrhea in patients with clinically suspected or diagnosed of CSF rhinorrhea. The MR cisternography is also an efficacious, noninvasive, cost-effective imaging technique that can detect a CSF fistula without the disadvantage of lumbar puncture, contrast injection and ionizing radiation. CT cisternography provides direct evidence of CSF leaks in cases with multiple defects. However, it is invasive, time consuming, low accepted by patients and contains morbidity rates including inherent risks of contrast complications. MR cisternography has the advantages over CTC, for being not dependent on active leakage for positive diagnosis, in cases of multiple dural defects and in cases with inactive (intermittent) leakage, and when the dural defect is less than 2 mm. The MR cisternography after intrathecal administration of Gd-DTPA is not currently approved worldwide. However, it represents a promising, effective, mildly invasive method that permits direct, sensitive visualization of spontaneous, post traumatic or post surgical CSF leak. Combining the HRCT with MRC, is now considered as the primary diagnostic method of choice for the investigation of patients with CSF rhinorrhea that gives the same information as contrast enhanced cisternography without any risk of related complications, contrast injection and eliminate the need for lumbar puncture . In addition, the MRC alone or in conjunction with HRCT is a viable alternative to invasive CTC and Gd-MRC. CTC and Gd-MRC with their associated complications and inconvenience should be used for the complicated cases and for cases with confirmed or highly suspected CSF leak and negative HRCT and MRC.