Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery

BACKGROUND: This study aimed to assess the efficacy of MR images with three-dimensional sampling perfection with application optimised contrast using different flip-angle evolution (3D-SPACE) sequence for detecting cerebrospinal fluid (CSF) rhinorrhea and image-guided surgery for the management of CSF rhinorrhea. MATERIALS AND METHODS: This study included 45 consecutive patients with suspected CSF rhinorrhea from 2010 to 2015. Patients underwent preoperative MRI scan including 3D-SPACE and conventional T2-weighted (T2W) protocol. Two-blinded neuroradiologists determined the presence and location of CSF leakage. Imaging results were compared with surgical findings and/or β-2 transferrin testing. Intraoperative navigation was used during endonasal endoscopic surgery for repairing CSF rhinorrhea. RESULTS: 3D-SPACE sequence correctly described 27 cases (93.1%) and conventional T2W sequence described only 20 (69.0%) of the total 29 patients with truly positive CSF leakage. The sensitivity, specificity, positive predictive value and negative predictive value for detecting CSF leakages were 93.1%, 87.5%, 93.1%, and 87.5% for 3D-SPACE, and 69.0%, 81.3%, 87.0% and 59.1% for T2W, respectively. To repair the leakage, 3D-SPACE image-guided navigation was used to locate the CSF leakage sites intraoperatively. Only two CSF leakage sites proved by surgery were missed by navigation. Successful endoscopic repairs were achieved in 25 of 26 (96.2%) patients during the first attempt. During the follow-up, there were no major postoperative complications or recurrences encountered. CONCLUSION: MR imaging with 3D-SPACE sequence is an effective and reliable method with higher sensitivity and specificity than T2W for detecting CSF leakage. Intraoperative 3D-SPACE image-guided navigation is helpful in locating the sites of the CSF leakage during endonasal endoscopic surgery.