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Fig. 16. CT findings of site of CSF leak include osseous defect along the skull base, particularly with fluid/opaci fication within the adjacent nasal cavity or sinus. ( A ) Axial CT showing linear defect in the planum sphenoidale and fluid level in the sphenoid sinus ( arrow ). ( B ) Coronal CT showing polypoid nondependent soft tissue in the left olfactory recess, suspicious for meningocele ( arrow ).

Fig. 17. CTcisternogramfindings of CSF leak. ( A ) Polypoidnondependent soft tissue adjacent toosseous defect in the left olfactory recess, which increases in attenuation from the precontrast ( B ) to the postcontrast ( C ) cisternogram im ages ( arrows ), confirming the site of leak. ( D , E ) Direct coronal imaging of another patient in the prone position, showing rapid washout of the CSF intracranially on the side of the leak compared with the other side ( arrow in D ), as well as the souffle´ effect of layering of the dense contrast dependently in a patient with active leak along the right ethmoid roof into the ethmoid sinuses ( thick arrow inD ). Note also themovement of contrast with changes inpatient position, as seen in this patient with contrast trickling anteriorly out of the nose in the prone position ( arrow in E ).

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