Magnetic Resonance Venography and Spontaneous Cerebrospinal Fluid Leaks to the Temporal Bone

Background: Spontaneous cerebrospinal fluid (CSF) leaks are associated with idiopathic intracranial hypertension (IIH). Magnetic resonance venography (MRV) can unveil anatomical findings that raise suspicion for IIH. To date, there is limited research on the utility of MRV in the diagnosis and management of spontaneous CSF otorrhea. The objective of this study is to describe MRV findings in patients diagnosed with spontaneous CSF otorrhea to the temporal bone.

Methods: Electronic medical record query of two neurotologists' patients at an academic, urban, tertiary medical center found 16 patients with documented CSF leak to the temporal bone and MRV performed between January 2008 and December 2019. All 16 patients presented with spontaneous CSF otorrhea. Radiologist reports from MRV, MRI, and CT scans were reviewed. If radiologist did not comment on specific anatomical structures, those patients were not included in the percentage calculation for that particular finding.

Results: Fifteen of 16 patients were female; the average BMI was 38.5 with a standard error of 2.9. All 16 patients had concomitant MRI and 10 had a CT performed. Two of 16 patients had definitive IIH prior to MRV. MRV imaging revealed 9 of 16 (56.3%) patients had bilateral transverse sinus stenosis. Two of 16 (12.5%) patients had unilateral stenosis. Five of 12 (41.7%) patients had bilaterally enlarged Meckel caves, and 0 of 12 patients had unilateral enlargement. Six of 13(46.2%) patients had noticeable optic sheath dilation. Eleven of 16 (68.8%) patients were suspected to have IIH based on MRV findings.

Based on MRI and CT findings, 0 of 13 patients had noticeable osseous venous sinus malformations. Twelve of 15 (80.0%) patients had either a partial or completely empty Sella Turcica. One of 13 (7.7 percent) patients had increased optic nerve tortuosity. Zero of 13 patients had noticeable globe flattening.

Conclusion: MRV may be useful in the workup of patients with CSF leak and suspected IIH, yet its utility in the management of spontaneous CSF otorrhea has not been established. This study demonstrates that the majority of patients with spontaneous CSF otorrhea had suspected IIH based on MRV findings. Further research is necessary to determine how MRV can be used in the diagnosis and management of spontaneous CSF otorrhea.

Publication History

Article published online:
12 February 2021