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Parmar HA, Ibrahim M. Imaging of Anterior Skull Base. Semin Ultrasound CT MR 2021; 42:281-294. [PMID: 34147163 DOI: 10.1053/j.sult.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hemant A Parmar
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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Investigation of Skull-Based Cerebrospinal Fluid Leak Repair: A Single-Institution Comprehensive Study of 116 Cases Over 10 Years. World Neurosurg 2019; 135:e1-e11. [PMID: 31604132 DOI: 10.1016/j.wneu.2019.09.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leaks have been historically difficult to diagnose and treat because their cause can widely vary. There are insufficient diagnostic predictors and no clinically accepted standards for their treatment. This large institutional study reports on the diagnosis, management, and outcomes of patients presenting with CSF leak over 10 years and aims to identify potential comorbidities and risk factors for primary and recurrent leaks. METHODS Patients diagnosed with CSF leak from 2007 to 2017 were analyzed retrospectively. The data included medical history, body mass index, surgical treatment, and postoperative outcomes. RESULTS A total of 116 cases were identified. The location of leaks was 91 CSF rhinorrhea and 28 CSF otorrhea (3 both). The average BMI for females was greater than that of males (P = 0.01). Causes of leak were 64 noniatrogenic, 47 iatrogenic, and 9 traumatic. A total of 108 patients underwent surgical treatment. Sixty-nine were treated by endoscopic approaches, 42 involved open approaches, and 83 involved the placement of a lumbar drain. Eighteen patients had a ventriculoperitoneal shunt and 6 had a lumbar-peritoneal shunt. A total of 78 patients (72.22%) had an associated encephalocele with the CSF leak. The average length of stay was 7.73 days (0.76). The average length of follow-up was 1.58 years (0.22). The primary repair rate was 80.17% (n = 93) and the overall repair outcome was 99.14% (n = 115). CONCLUSIONS The overall CSF repair outcome was 99.14% over 10 years at a single institution. Despite this high percentage, CSF leaks continue to be a complex problem and require vigorous multidisciplinary work with close follow-up and use of multiple imaging strategies.
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Laboratory testing and imaging in the evaluation of cranial cerebrospinal fluid leaks and encephaloceles. Curr Opin Otolaryngol Head Neck Surg 2019; 27:339-343. [DOI: 10.1097/moo.0000000000000578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kita AE, Bradbury DW, Taylor ZD, Kamei DT, St John MA. Point-of-Care Cerebrospinal Fluid Detection. Otolaryngol Head Neck Surg 2018; 159:824-829. [PMID: 30040545 DOI: 10.1177/0194599818789075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A cerebrospinal fluid leak is one of the most serious complications in otolaryngology. It may occur as a result of injury to the skull base, typically traumatic or iatrogenic. While the presence of a leak is often discerned in the emergent setting, distinguishing normal secretions from those containing cerebrospinal fluid can be difficult during postoperative visits in the clinic. As most current laboratory-based assays are labor intensive and require several days to result, we aim to develop a more user-friendly and rapid point-of-care cerebrospinal fluid detection device. STUDY DESIGN Our laboratory developed a barcode-style lateral-flow immunoassay utilizing antibodies for beta-trace protein, a protein abundant in and specific for cerebrospinal fluid, with a concentration of 1.3 mg/L delineating a positive result. SETTING Tertiary medical center. SUBJECTS AND METHODS Tests with known concentrations of resuspended beta-trace protein and the contents of discarded lumbar drains (presumed to contain cerebrospinal fluid) were performed to validate our novel device. RESULTS Our results demonstrate the ability of our device to semiquantitatively identify concentrations of beta-trace protein from 0.3-90 mg/L, which is within the required range to diagnose a leak, thus making beta-trace protein an excellent target for rapid clinical detection. CONCLUSION Herein we detail the creation and initial validation of the first point-of-care cerebrospinal fluid detection device. This device is a feasible method to more efficiently and cost-effectively identify cerebrospinal fluid leaks, minimize costs, and improve patient outcomes.
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Affiliation(s)
- Ashley E Kita
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel W Bradbury
- 2 Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Zachary D Taylor
- 2 Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, California, USA.,3 UCLA Head and Neck Cancer Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,4 Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel T Kamei
- 2 Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Maie A St John
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,3 UCLA Head and Neck Cancer Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,5 Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Zervos TM, Macki M, Cook B, Schultz LR, Rock JP, Craig JR. Beta-2 transferrin is detectable for 14 days whether refrigerated or stored at room temperature. Int Forum Allergy Rhinol 2018; 8:1052-1055. [PMID: 29722921 DOI: 10.1002/alr.22136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/24/2018] [Accepted: 04/10/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The effect of time and temperature on beta-2 transferrin stability in cerebrospinal fluid (CSF) is not well established. After collecting nasal CSF for testing, beta-2 transferrin has been found to be stable and detectable for 1 week, whether being refrigerated or stored at room temperature. The purpose of this study was to determine if beta-2 transferrin remained detectable longer than 1 week and whether refrigeration improved its detectability. METHODS In patients undergoing therapeutic CSF diversion, 2-mL CSF samples were collected from 18 patients. The samples were divided and stored either at room temperature, or at 4°C, and tested for beta-2 transferrin at 7 and 14 days. CSF was collected from external ventricular drains (EVDs) (n = 15), lumbar drains (n = 2), and subdural drains (n = 1). RESULTS Of the 18 CSF samples originally testing positive for beta-2 transferrin, none turned negative at 7 or 14 days, in both the refrigerated and room temperature groups (95% confidence interval [CI], 0% to 18.5%). CONCLUSION Beta-2 transferrin remained detectable for 14 days in all CSF samples, regardless of being stored at 4°C or room temperature.
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Affiliation(s)
- Thomas M Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI
| | - Bernard Cook
- Department of Pathology, Henry Ford Hospital, Detroit, MI
| | - Lonnie R Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI
| | - Jack P Rock
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
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"Dickkopf-Related Protein 3 as a Sensitive and Specific Marker for Cerebrospinal Fluid Leaks. Otology & Neurotology 2016;37: 299-303". Otol Neurotol 2017; 38:610-611. [PMID: 28125516 DOI: 10.1097/mao.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morell-Garcia D, Bauça JM, Sastre MP, Yañez A, Llompart I. Sample-dependent diagnostic accuracy of prostaglandin D synthase in cerebrospinal fluid leak. Clin Biochem 2016; 50:27-31. [PMID: 27614217 DOI: 10.1016/j.clinbiochem.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostaglandin D2 synthase, commonly known as β-trace protein (βTP), is an excellent biomarker for the assessment of cerebrospinal fluid (CSF) leaks. Despite being widely used, the limits for the diagnostic values of βTP are not well established to date, and currently suggested cut-off values in literature range from 0.25 to 6.0mg/L. Sample-specific and more accurate thresholds are a current need. METHODS A retrospective observational study, performed in a tertiary-care hospital, between January 2006 and January 2014. A total of 74 patients were included, with a definitive diagnosis after initial leak suspicion and at least one determination of βTP using a nephelometry-based assay. A total of 46 CSF samples were included in the control group. Samples were obtained from nasal secretions, ear secretions or spinal surgical injury, directly using sterile Eppendorf tubes. The analysis of 3 different cut-off values was performed and the receiver operating curve (ROC) analyses were calculated. RESULTS Initial diagnostic suspicion was confirmed in 51% of cases, most of which were of postoperative origin (51%) and traumatic (26%). The βTP median concentration in different samples was significantly higher in the presence of cerebrospinal fluid fistula, regardless of sample type (22.0mg/L vs. 0.24mg/L, 95% confidence interval: 19.0-30.8 vs. 0.08-0.40; p<0.001). Data from contingency tables show 100% sensitivity and specificity, depending on sample type and the cut-off value used: for rhinorrhea and otorrhea samples, the most appropriate it was 0.7mg/L, while values >2.0mg/L could be used for spine postoperative fluid leakage samples. CONCLUSIONS The cut off value for βTP in the diagnosis and follow-up of cerebrospinal fluid leaks should be modified depending on the type of secretion (sample type), for a better diagnostic accuracy.
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Affiliation(s)
- Daniel Morell-Garcia
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain.
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain
| | - M Pilar Sastre
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Aina Yañez
- Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain
| | - Isabel Llompart
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
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Abstract
Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.
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Affiliation(s)
- Rodney C Diaz
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Hilary A Brodie
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California, United States
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Abstract
Rhinitis is characterized by one or more of the following nasal symptoms: congestion, rhinorrhea (anterior and posterior), sneezing, and itching. It is classified as allergic or nonallergic, the latter being a diverse syndrome that is characterized by symptoms of rhinitis that are not the result of IgE-mediated events. Excluding infectious rhinitis and underlying systemic diseases, clinical entities that can be classified among the disorders that make up the nonallergic rhinitis syndromes include gustatory rhinitis, nonallergic rhinitis with eosinophilia syndrome (NARES), atrophic, drug-induced (rhinitis medicamentosa), hormone induced, senile rhinitis (of the elderly), rhinitis associated with chronic rhinosinusitis with or without nasal polyps, and the idiopathic variant formerly known as vasomotor rhinitis but more accurately denoted as nonallergic rhinopathy (NAR). The prevalence of nonallergic rhinitis has been observed to be one-third that of allergic rhinitis, affecting ~7% of the U.S. population or ~22 million people. NAR is the most common of the nonallergic rhinitis subtypes, comprising at least two-thirds of all nonallergic rhinitis sufferers. Although certain precipitants such as perfume, strong odors, changes in temperature or humidity, and exposure to tobacco smoke are frequently identified as symptom triggers, NAR may occur in the absence of defined triggers. The diagnosis of nonallergic rhinitis is purely clinical and relies on a detailed history and physical exam. Skin testing or in vitro testing to seasonal and perennial aeroallergens is required to make the diagnosis of nonallergic rhinitis. Because of the heterogeneous nature of this group of disorders, treatment should be individualized to the patient's underlying pathophysiology and/or symptoms and is often empiric.
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Affiliation(s)
- Russell A Settipane
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Juraschek SP, Coresh J, Inker LA, Levey AS, Köttgen A, Foster MC, Astor BC, Eckfeldt JH, Selvin E. Comparison of serum concentrations of β-trace protein, β2-microglobulin, cystatin C, and creatinine in the US population. Clin J Am Soc Nephrol 2013; 8:584-92. [PMID: 23335043 DOI: 10.2215/cjn.08700812] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES β-trace protein (βTP), β2-microglobulin (β2M), and cystatin C (CysC) have advantages over creatinine for estimating GFR and prognosis. This study compares the distribution of all four markers in the general population and their associations with possible determinants of GFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS βTP and β2M were measured in 7596 participants (aged ≥12 years) of the Third National Health and Nutrition Examination Survey (1988-1994). βTP and β2M concentrations and the proportion of persons with elevated (≥99th percentile for young healthy participants) βTP (≥0.81 mg/L), β2M (≥2.80 mg/L), standardized CysC (≥1.03 mg/L), and creatinine (≥1.2 mg/dl for men and ≥1.0 mg/dl for women) were compared across demographic and clinical factors. RESULTS Elevated βTP, β2M, and CysC showed stronger associations with age than elevated serum creatinine, the prevalence of elevated levels reaching 47%, 44%, 58%, and 26%, respectively, by age 80 years. βTP, CysC, and creatinine were higher in men but β2M was not associated with sex. Mexican Americans had lower βTP, β2M, CysC, and creatinine compared with non-Hispanic whites. Hypertension and higher C-reactive protein were associated with elevations in all markers, whereas non-Hispanic black race, body mass index, diabetes, smoking status, triglycerides, HDL cholesterol, and education were not associated in a consistent manner across the different markers. CONCLUSIONS βTP, β2M, CysC, and creatinine differ in their associations with demographic and clinical factors, suggesting variation in their non-GFR determinants. Future studies should examine these markers with measured GFR to determine their diagnostic and prognostic utility.
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Affiliation(s)
- Stephen P Juraschek
- Departments of Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Duntze J, Litré C, Graillon T, Maduri R, Pech-gourg G, Rakotozanany P, Gras R, Dufour H. Rhinorrhée cérébrospinale après chirurgie hypophysaire endoscopique trans-sphénoïdale : réflexions après 337 patients. Neurochirurgie 2012; 58:241-5. [DOI: 10.1016/j.neuchi.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 01/09/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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Wagenmann M, Schipper J. The transnasal approach to the skull base. From sinus surgery to skull base surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc08. [PMID: 22558058 PMCID: PMC3341585 DOI: 10.3205/cto000081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The indications for endonasal endoscopic approaches to diseases of the skull base and its adjacent structures have expanded considerably during the last decades. This is not only due to improved technical possibilities such as intraoperative navigation, the development of specialized instruments, and the compilation of anatomical studies from the endoscopic perspective but also related to the accumulating experience with endoscopic procedures of the skull base by multidisciplinary centers. Endoscopic endonasal operations permit new approaches to deeply seated lesions and are characterized by a reduced manipulation of neurovascular structures and brain parenchyma while at the same time providing improved visualization. They reduce the trauma caused by the approach, avoid skin incisions and minimize the surgical morbidity. Transnasal endoscopic procedures for the closure of small and large skull base defects have proven to be reliable and more successful than operations with craniotomies. The development of new local and regional vascularized flaps like the Hadad-flap have contributed to this. These reconstructive techniques are furthermore effectively utilized in tumor surgery in this region. This review delineates the classification of expanded endonasal approaches in detail. They provide access to lesions of the anterior, middle and partly also to the posterior cranial fossa. Successful management of these complex procedures requires a close interdisciplinary collaboration as well as continuous education and training of all team members.
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Affiliation(s)
- Martin Wagenmann
- Dept. of Otorhinolaryngology, Head & Neck Surgery (HNO-Klinik) Düsseldorf University Hospital, Düsseldorf, Germany
| | - Jörg Schipper
- Dept. of Otorhinolaryngology, Head & Neck Surgery (HNO-Klinik) Düsseldorf University Hospital, Düsseldorf, Germany
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Rule AD, Bailey KR, Turner ST. What Is the Goal With Endogenous Filtration Markers—Estimation of GFR or Prediction of Kidney Outcomes? Am J Kidney Dis 2011; 58:865-7. [DOI: 10.1053/j.ajkd.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/11/2022]
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Reguera A, González MÁ, Sánchez A, Aguayo C. [Streptococcus agalactiae meningitis in an immunocompetent male]. Enferm Infecc Microbiol Clin 2011; 29:707-8. [PMID: 21940070 DOI: 10.1016/j.eimc.2011.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/25/2011] [Accepted: 05/30/2011] [Indexed: 11/17/2022]
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Kondabolu S, Adsumelli R, Schabel J, Glass P, Pentyala S. Evaluation of prostaglandin D2 as a CSF leak marker: implications in safe epidural anesthesia. Local Reg Anesth 2011; 4:21-4. [PMID: 22915888 PMCID: PMC3417968 DOI: 10.2147/lra.s18053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background It is accepted that there is a severe risk of dural puncture in epidural anesthesia. Of major concern to anesthesiologists is unintentional spinal block. Reliable identification of cerebrospinal fluid (CSF) from the aspirate is crucial for safe epidural anesthesia. The aim of this study was to determine whether prostaglandin D2 could be clinically used as a marker for the detection of CSF traces. Methods After obtaining Institutional Review Board approval and patient consent, CSF was obtained from patients undergoing spinal anesthesia, and blood, urine, and saliva were obtained from normal subjects and analyzed for prostaglandin D2 (PGD). CSF (n=5) samples were diluted with local anesthetic (bupivacaine), normal saline and blood in the ratios of 1:5 and 1:10. PGD levels in the CSF samples were analyzed with a PGD-Methoxime (MOX) EIA Kit (Cayman Chemicals, MI). This assay is based on the conversion of PGD to a stable derivative, which is analyzed with antiserum specific for PGD-MOX. Results Different concentrations of pure PGD-MOX conjugate were analyzed by EIA and a standard curve was derived. PGD levels in CSF and CSF with diluents were determined and the values were extrapolated onto the standard curve. Our results show a well-defined correlation for the presence of PGD both in straight CSF samples and in diluted CSF (dilution factor of 1:5 and 1:10). Conclusion Prostaglandin D2 was reliably identified in CSF by enzyme-linked immunosorbent assay when diluted with local anesthetic, saline, and serum, and can be used as a marker to identify the presence of CSF in epidural aspirates.
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Affiliation(s)
- Sirish Kondabolu
- Department of Anesthesiology, School of Medicine, Stony Brook Medical Center, Stony Brook, New York, USA
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mantur M, Łukaszewicz-Zając M, Mroczko B, Kułakowska A, Ganslandt O, Kemona H, Szmitkowski M, Drozdowski W, Zimmermann R, Kornhuber J, Lewczuk P. Cerebrospinal fluid leakage--reliable diagnostic methods. Clin Chim Acta 2011; 412:837-40. [PMID: 21334321 DOI: 10.1016/j.cca.2011.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/09/2011] [Accepted: 02/11/2011] [Indexed: 11/28/2022]
Abstract
Prompt diagnosis and early treatment of cerebrospinal fluid (CSF) leakage minimizes the risk of severe complications. In patients presenting with clear fluid nasal discharge it is important to identify the nature of the rhinorrhea. The CSF leakage may occur as post-traumatic, iatrogenic, spontaneous or idiopathic rhinorrhea. The differential diagnosis of CSF rhinorrhea often presents a challenging problem. The confirmation of CSF rhinorrhea and localization of the leakage may be diagnosed by CT, MRI cisternography and MRI cisternography in combination with single photon emission tomography or radioisotopic imaging. Although these methods allow estimation of the CSF leakage with high accuracy, they are expensive and invasive procedures. Therefore, biochemical methods are still used in the differentiation. Although the most common diagnostic method for screening CSF leakage is glucose oxidase, its diagnostic sensitivity and specificity is generally unsatisfactory. False negative results may occur with bacterial contamination and false positive results are common in diabetic patients. Glucose detection is not recommended as a confirmatory test. As such, other biomarkers of the CSF leakage, such as beta-2-transferrin (beta-2 trf) and beta-trace protein (betaTP) are necessary to identify and confirm of this condition.
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Affiliation(s)
- Maria Mantur
- Department of Clinical Laboratory Diagnostics, Medical University, Białystok, Poland
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