A cranial CSF leak or fistula is defined as a loss of CSF from the intracranial cavity resulting from an osseous defect in the skull base. It is related to disruption of the dura and arachnoid mater, leading to communication between the intracranial and nasal cavities [6]

Imaging plays a remarkable role in preoperative workup through localizing the site of the leak and determining the accurate dimensions of the osteodural defect [7]. However, there is no imaging “gold standard” for diagnosis of such important entity reflecting the difficulty of this diagnosis [3].

In our study, the most common cause of CSF rhinorrhea was spontaneous leakage; this is in agreement with Shetty et al. [8]. On the other hand, Yilmazlar et al. [9] reported that traumatic etiology was the most common cause. This is attributed to the selection of patients with a history of head injury in Yilmazlar et al. study population.

Twelve patients (24%) had normal imaging findings, ten of them experienced resolution of their CSF leak; this is comparable to Stone et al. [5], who stated that 28% of cases showed no bone defects or contrast leak. It is possible that the bone defects in these patients were tiny with inactive leakage in which the dripping is intermittent.

Our results showed that the most common site of the bony defect is the cribriform plate (50%) which is in line with Atta et al. [3], where 40% of their cases showed bone defects at cribriform plate, whereas Scholsem et al. [10] found a high percentage of leaks through cribriform plate (87%).

Our study stated that NCCT detected bone defects in 30 cases (75%), while CECTC detected contrast leak in 35 cases (87.5%); this is against Lupo et al. [11], who stated that 100% of bony defects could be detected by NCCT, while 84.6% only of cases showed contrast leak in CECTC; this may be attributed to small sample size in their study; also in our study, nearly 50% of cases showed defect at cribriform plate, which is a sieve-like structure and is normally perforated by olfactory nerve. On the other side, our results were comparable with stone et al. as regards NCCT defect detection which was 71%, while no added cases by CECTC in that study, which disagreed with our study that added 5 more cases [5].

Our results showed that NCCT showed a sensitivity of 74%; this is lower than Shetty et al. [8] who showed a sensitivity of 92% but both studies showed the same specificity of 100%.

Our results showed that CECTC showed a sensitivity of 87%; this is relatively higher than Eberhardt et al. [12], who stated that its sensitivity equals 72.3%.

We consider that the greatest advantage of NCCT added to CECTC is precise anatomical localization of the osseous defect with definitive proof of CSF leak. This was confirmed by results in the current study which showed higher sensitivity of combined NCCT and CECTC of 95% and specificity of 100%, compared to either modality alone.

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