Cerebrospinal fluid leak [G96.0]. Possible meningocele. Patient presented with CSF rhinorrhea on the left and has a history of remote left sinus surgery. There is a low T2 signal likely enhancing extra-axial 1.1 x 0.9 cm mass overlying the left parietal lobe near the vertex with a small dural tail most consistent with meningioma (series 4 image 175). No additional enhancing intracranial masses are identified. There is no significant intracranial mass effect or hydrocephalus.The left cribriform plate dehiscence was better visualized on prior CT. However, a small amount of fluid is again illustrated in the left olfactory recess. No gross brain herniation is seen, though this limited postoperative examination is not optimized for detection of such findings. The defect in the right tegmen was better seen on prior CT as well. There is again with partial filling of the right mastoid air cells and upper right middle ear cavity with fluid signal. Postoperative findings related to partial ethmoidectomy and uncinectomy bilaterally are again noted. Bilateral Haller cells are redemonstrated. The left Haller cells again demonstrates mild mucosal thickening and secretions. There is also mild mucosal thickening of the maxillary sinuses and a small retention cysts in the left maxillary sinuses.
1. Defect in the left cribriform plate was better assessed on prior CT. However, fluid signal in the left olfactory recess is again suggestive of cerebrospinal fluid leakage at this location. No gross brain parenchymal herniation is suspected. 2. Defect in the right tegmen with partial opacification of the right mastoid air cells and upper right middle ear cavity, also better seen on prior CT, which may represent an additional site of potential CSF leakage. 3. Postoperative findings related to partial ethmoid sinus resection and resection of the medial walls of the bilateral maxillary sinuses, unchanged and better seen on prior CT.4. 1.1 cm extra-axial mass overlying the left parietal lobe near the vertex likely relates to a meningioma. No significant intracranial mass effect. Correlation with outside imaging may be beneficial.