Positional MRI: a technique for confirming the site of leakage in cerebrospinal fluid rhinorrhoea

Abstract

We report confirmation of the site of leakage in two patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea by demonstrating CSF leaking on MRI. Both patients had midline anterior cranial fossa floor (cribriform plate/fovea ethmoidalis) dural-bone defects with arachnoid herniation with or without brain herniation into the upper part of the nasal cavity on MRI, which was subsequently confirmed surgically. Corresponding to the history of postural induction or aggravation of the rhinorrhoea, the CSF leak was demonstrated by the appearance of or increase in the sinonasal fluid collection by imaging the patient in the position of maximum leakage following initial images in the supine position.