title: A novel finding on computed tomography in the diagnosis and localization of cerebrospinal fluid leaks without a clear bony defect.
abstract: BACKGROUND
  The purpose of this work was to describe a clinical and radiographic pattern of findings that helps localize the site of spontaneous cerebrospinal fluid (CSF) leaks.
  
  
  METHODS
  This study was a retrospective review of CSF leaks treated at the University of Texas Southwestern Medical Center from 2000 to 2009. Data collected included demographics, nature of presentation, imaging findings, intraoperative location of skull-base defect, and clinical follow-up.
  
  
  RESULTS
  Forty-six patients' charts were reviewed. Among these patients, 15 did not show a bony skull-base defect on high-resolution computed tomography (CT) scan. They did, however, each show a small area of opacification in the olfactory cleft. In each case, this area of opacification correlated with the site of the CSF leak. Intrathecal fluorescein was not used, except in 2 instances. Successful repair was noted in all patients on follow-up, without evidence of recurrence at the repair site.
  
  
  CONCLUSIONS
  In the absence of a clearly identifiable bony skull-base defect, opacification of the olfactory cleft is a localizing sign in some cases of spontaneous CSF rhinorrhea. Such a finding should direct endoscopic repair, and may serve as the only marker for the specific leak site.
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. rpeter.manes@yale.edu
authors.forename: R Peter
authors.initials: RP
authors.lastname: Manes
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Ryan
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Marple
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009830:Olfactory Bulb / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*