The diagnosis of cerebrospinal fluid (CSF) rhinorrhea or otorrhea (leakage of CSF into the nose or ear canal, usually as a result of head trauma, tumor, congenital malformation, or surgery) is often difficult to confirm. Factors associated with increased recurrences are middle age, obese female, raised ICP, diabetes mellitus, lateral sphenoid leaks, superior and lateral extension in frontal sinus, multiple leaks, and extensive skull base defects. HHS Next issue (October): Blunt carotid and vertebral injury. Therefore, beta2-transferrin is located only within the CSF, perilymph, and aqueous humor. Otolaryngology and Facial Plastic Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Academy of Facial Plastic and Reconstructive Surgery. Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H. Asian J Neurosurg. Beta-2 transferrin test confirms the diagnosis. Albu S, Florian IS, Bolboaca SD. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. Prehospital provider Nerve Damage Linked to Prone Positioning in COVID-19. 2004 Aug. 114(8):1475-81. See this image and copyright information in PMC. T2-weighted imaging can be used to detect the presence of CSF in the sinonasal cavity without the invasiveness of contrast injection. However, we anticipate that modified glucose testing, as proposed in our algorithm, could support clinical decision making, particularly in situations where more complex tests for CSF leak are not available. J Neurosurg. | [Medline]. Domengie F, Cottier JP, Lescanne E, Aesch B, Vinikoff-Sonier C, Gallas S, Herbreteau D. J Neuroradiol. Please enable it to take advantage of the complete set of features! Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks Using Multilayer Composite Graft and Vascularized Pedicled Nasoseptal Flap Technique. Endoscopic closure has revolutionized the management of CSF rhinorrhea due to its less morbidity and better closure rate. [Medline]. Give leaks healed spontaneously with conservative management. In addition, MRI is more costly and more time consuming. USA.gov. 2015 Jan-Feb. 29 (1):77-81. Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Please enable it to take advantage of the complete set of features! Radioactive isotopes can be introduced into the CSF by means of a lumbar or suboccipital puncture. NLM Patel K, Memon Z, Prince A, Park C, Sajan A, Ilyas N. BMC Infect Dis. 2014 Jun. [Medline]. Ray BS, Bergland RM. [Full Text]. [Medline]. 2004 Jan;31(1):47-59. doi: 10.1016/s0150-9861(04)96878-2. Beta-2 transferrin is currently single best laboratory test for identifying the presence of CSF in sinonasal fluid. Click the image above to visit their site and download your copy! However, the US Food and Drug Administration has not approved the use of fluorescein for this purpose. The contact of cerebrospinal fluid (CSF) with the stabilization solution contained in these tubes changes the migration and the result is not interpretable. Keywords: Interpretation of the results is confounded In most instances, fluorescein is visible with standard xenon light sources used during endoscopic sinus surgery.
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