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Hickman PE, Salib MM, Simpson A, Potter JM. Use of chloride gradient for rapid identification of CSF leaks. Pathology 2024; 56:579-581. [PMID: 37968176 DOI: 10.1016/j.pathol.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Peter E Hickman
- ACT Pathology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, The Canberra Hospital, Garran, ACT, Australia.
| | - Marie M Salib
- ACT Pathology, The Canberra Hospital, Garran, ACT, Australia
| | - Aaron Simpson
- Clinipath Pathology, Osborne Park, WA, Australia; PathWest, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Julia M Potter
- ACT Pathology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, The Canberra Hospital, Garran, ACT, Australia
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2
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Oh HK, Park J, Sonstein WJ, Maher S, Kim MG. Development and Clinical Validation of a Hook Effect-Based Lateral Flow Immunoassay Sensor for Cerebrospinal Fluid Leak Detection. Neurosurgery 2024:00006123-990000000-01114. [PMID: 38578087 DOI: 10.1227/neu.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rapid detection of cerebrospinal fluid (CSF) leaks is vital for patient recovery after spinal surgery. However, distinguishing CSF-specific transferrin (TF) from serum TF using lateral flow immunoassays (LFI) is challenging due to their structural similarities. This study aims to develop a novel point-of-care diagnostic assay for precise CSF leak detection by quantifying total TF in both CSF and serum. METHODS Capitalizing on the substantial 100-fold difference in TF concentrations between CSF and serum, we designed a diagnostic platform based on the well-known "hook effect" resulting from excessive analyte presence. Clinical samples from 37 patients were meticulously tested using the novel LFI sensor, alongside immunofixation as a reference standard. RESULTS The hook effect-based LFI sensor exhibited outstanding performance, successfully discriminating positive clinical CSF samples from negative ones with remarkable statistical significance (positive vs negative t-test; P = 1.36E-05). This novel sensor achieved an impressive 100% sensitivity and 100% specificity in CSF leak detection, demonstrating its robust diagnostic capabilities. CONCLUSION In conclusion, our study introduces a rapid, highly specific, and sensitive point-of-care test for CSF leak detection, harnessing the distinctive TF concentration profile in CSF compared with serum. This novel hook effect-based LFI sensor holds great promise for improving patient outcomes in the context of spinal surgery and postsurgical recovery. Its ease of use and reliability make it a valuable tool in clinical practice, ensuring timely and accurate CSF leak detection to enhance patient care.
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Affiliation(s)
- Hyun-Kyung Oh
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Jinhee Park
- GMD Biotech Inc., Cop., Gwangju, Republic of Korea
| | - William J Sonstein
- Neurological Surgery, P.C., Hempstead, New York, USA
- Department of Neurosurgery, NYU Langone Hospital Long Island, Mineola, New York, USA
| | - Simon Maher
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- GMD Biotech Inc., Cop., Gwangju, Republic of Korea
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3
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Kemps GJ, de Boer D, Tijssen MP, Kunst DH, Waterval JJ. CSF or middle ear effusion? Diagnostical dilemmas in a patient with temporal bone meningioma: A case report. Heliyon 2024; 10:e28059. [PMID: 38524529 PMCID: PMC10957423 DOI: 10.1016/j.heliyon.2024.e28059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Cerebrospinal fluid (CSF) fistulas are a rare phenomenon, that can lead to life-threatening complications if left untreated. Presenting as rhinorrhea or otorrhea, they can be difficult to diagnose due to admixture of other bodily fluids. Typically, CSF fistulas develop after trauma, but in rare instances, they can be diagnosed in patients with a neoplastic lesion. Objective To discuss several steps in diagnosing CSF fistulas. Patient A fifty-year-old female with an intra-osseous temporal bone meningioma. Interventions For diagnosing CSF admixture in fluids, two tests are looked into: beta-2 transferrin (β2T) and beta-trace protein (βTP) testing. Conclusion Testing for βTP is a highly sensitive, quick and non-invasive method to assess CSF admixture in middle ear effusion. Because of its lower cost, faster results and easy sample collection, βTP testing has in our clinic replaced β2T testing. The current case illustrates a rare etiology of a CSF fistula, where β2T testing presumably showed false-negative results and βTP testing showed true-positive results.
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Affiliation(s)
- Glen J.F. Kemps
- Department of Otolaryngology, Isala Hospital, Zwolle, the Netherlands
| | - Douwe de Boer
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Maud P.M. Tijssen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dirk H.P.M. Kunst
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jérôme J. Waterval
- Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Lee HS, Cho KR, Park K, Jeon C. Management of Cerebrospinal Fluid Leakage after Microvascular Decompression Surgery: Clinical Strategy. Life (Basel) 2023; 13:1771. [PMID: 37629628 PMCID: PMC10455648 DOI: 10.3390/life13081771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Cerebrospinal fluid (CSF) leakage is one of the most common complications of microvascular decompression (MVD) surgery. Before fatal complications, such as intracranial infection, occur, early recognition and prompt treatment are essential. (2) Methods: The clinical data of 475 patients who underwent MVD surgery from September 2020 to March 2023 were retrospectively analyzed. In these patients, if there were any symptoms of CSF leakage, and if CSF leakage was evident, a lumbar drainage catheter was inserted immediately. (3) Results: CSF leakage was suspected in 18 (3.8%) patients. Five of these patients (1.1%) showed signs of CSF leakage during conservative management and subsequently underwent catheter insertion for lumbar drainage. The lumbar drain was removed after an average of 5.2 days, resulting in an average hospitalization of 14.8 days. In all 5 patients, CSF leakage was resolved without reoperation. (4) Conclusions: Our treatment strategy prevented the development of fatal complications. Close observation of the symptoms and postoperative temporal bone computed tomography and audiometry are considered to be good evaluation methods for all patients. If CSF leakage is certain, it is important to perform lumbar drainage immediately.
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Affiliation(s)
- Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (H.-S.L.); (K.-R.C.); (K.P.)
| | - Kyung-Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (H.-S.L.); (K.-R.C.); (K.P.)
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (H.-S.L.); (K.-R.C.); (K.P.)
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06171, Republic of Korea
| | - Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
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5
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Ali M, Elgassim MA, Faisal HM, Saied ASS, Elgassim M. Spontaneous Cerebrospinal Fluid Rhinorrhea Secondary to Idiopathic Intracranial Hypertension. Cureus 2023; 15:e42353. [PMID: 37621837 PMCID: PMC10445175 DOI: 10.7759/cureus.42353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
The cerebrospinal fluid (CSF) is a physiological fluid that functions to protect the brain tissue and maintain intracranial pressure. Defects between the subarachnoid spaces and other spaces can cause CSF leaks. We report the case of a 37-year-old female with no known past medical history who presented to the emergency department with a history of headaches for two months, nasal drip for 1.5 months, and recurrent fevers. Idiopathic intracranial hypertension was confirmed by cranial magnetic resonance imaging (MRI) and transnasal endoscopic repair of a CSF leak defect, and an abdomen fat graft was performed followed by an Axium navigation-guided right ventriculoperitoneal shunt (VPS).
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Affiliation(s)
- Mohamed Ali
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Moayad A Elgassim
- Medical School, Taylor's University Lakeside Campus, Subang Jaya, MYS
| | | | | | - Mohamed Elgassim
- Medical School, Taylor's University Lakeside Campus, Subang Jaya, MYS
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6
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Chen K, Dai K, Liu Z, Liu J, Yu K, Lu A, Zhao P. Skull base reconstruction using in situ bone flap in patients with pituitary adenomas treated by endoscopic endonasal approach. Front Neurol 2023; 14:1194251. [PMID: 37388547 PMCID: PMC10303779 DOI: 10.3389/fneur.2023.1194251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The objective of this study is to study the effect of in situ bone flap (ISBF) repositioning, a recently proposed rigid skull base reconstruction technique, on patients diagnosed with pituitary adenoma undergoing endoscopic endonasal approach (EEA). Method A retrospective analysis was conducted on 188 patients with pituitary adenomas who underwent EEA from February 2018 to September 2022. Patients were divided into the ISBF group and non-ISBF group, according to whether ISBF was used during skull base reconstruction. Results Of the 75 patients in the non-ISBF group, 6 had postoperative cerebrospinal fluid (CSF) leakage (8%), while only 1 of 113 patients in the ISBF group (0.8%) had postoperative CSF leakage, indicating that the incidence of postoperative CSF leakage in the ISBF group was significantly lower than that in the non-ISBF group (P = 0.033). In addition, we also found that the postoperative hospitalization days of patients in the ISBF group (5.34 ± 1.24) were significantly less than those in the non-ISBF group (6.83 ± 1.91, P = 0.015). Conclusion ISBF repositioning is a safe, effective, and convenient rigid skull base reconstruction method for patients with pituitary adenoma treated by EEA, which can significantly reduce the rate of postoperative CSF leakage and shorten postoperative hospital stays.
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7
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Li S, Lu T, Wang Y, Guo M, Ma R, Li S, Ruan B. Spontaneous Cerebrospinal Fluid Rhinorrhea and Otorrhea: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613231158797. [PMID: 36812427 DOI: 10.1177/01455613231158797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Spontaneous cerebrospinal fluid (CSF) leak is a condition that commonly presents with unilateral watery drainage from the nose or ear, tinnitus, and stuffy ears or hearing loss. Spontaneous CSF rhinorrhea and otorrhea together are rare. A 64-year-old woman presented at our department with complaints of clear watery rhinorrhea and hearing loss on the right side persisting for 10 months. Imaging and surgery were used to diagnose the condition. Through surgical treatment, she was eventually cured. Review of the literature has shown that patients with both nasal and aural CSF leaks are rare. When a patient presents with both unilateral watery drainage from both the nose and ear, a diagnosis of CSF rhinorrhea and otorrhea should be considered. This case report will benefit clinicians by providing more information to assist with diagnosing the disease.
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Affiliation(s)
- Shujuan Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Guo
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rongyue Ma
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuling Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Biao Ruan
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Alsaeedi BS, Alzamel HA, Alrasheedi AR, Bhat IN. Case report: Recurrent spontaneous cerebrospinal fluid (CSF) leak. Int J Surg Case Rep 2022; 100:107739. [DOI: 10.1016/j.ijscr.2022.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
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The Relationship Between the Myovertebral Structures and Idiopathic Cerebrospinal Fluid Leaks in Whiplash Injuries. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Cohen PR, Dorros SM. Lumbar Stenosis Spinal Surgery-Associated Cerebrospinal Fluid Leak Without Headache: An Autobiographical Case Report. Cureus 2022; 14:e25253. [PMID: 35755552 PMCID: PMC9217665 DOI: 10.7759/cureus.25253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
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Choi JI, Kim SD. Pediatric Minor Traumatic Brain Injury : Growing Skull Fracture, Traumatic Cerebrospinal Fluid Leakage, Concussion. J Korean Neurosurg Soc 2022; 65:348-353. [PMID: 35468709 PMCID: PMC9082117 DOI: 10.3340/jkns.2021.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health issue that causes significant morbidity and mortality in the pediatric population. Pediatric minor TBIs are the most common and are widely underreported because not all patients seek medical attention. The specific management of these patients is distinct from that of adult patients because of the different physiologies in these age groups. This article focuses on minor TBIs, particularly growing skull fractures, traumatic cerebrospinal fluid leakage, and concussion.
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Affiliation(s)
- Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
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Younis M, Adly M, Yousry M, Zahran A, Elmoheen A. Spontaneous Cerebro-Spinal Fluid Rhinorrhoea Caused by Sustained Intracranial Hypertension. Cureus 2022; 14:e24441. [PMID: 35637816 PMCID: PMC9129057 DOI: 10.7759/cureus.24441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Cerebrospinal Fluid (CSF) leakage results from a defect in the skull base, which communicates the subarachnoid space with the nasal cavity. The most common cause of CSF leakage is traumatic, and non-traumatic causes are less common. This case report illustrates a case of a woman who presented to the emergency department with clear fluid pouring from her nose for three weeks with a fever. The patient had pneumococcal meningitis and Idiopathic Intracranial Hypertension (ICH) seven years ago. Computed Tomography (CT) sinuses showed the defect seen on the right side of the cribriform plate, and the Magnetic Resonant Imaging (MRI) confirmed the CSF leakage. The CSF leakage was diagnosed by positive B transferrin. This case highlights a rare condition that needs early detection and treatment to prevent complications such as ascending meningitis.
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Zwayed AH, Lucke-Wold B. Cerebral Spinal Fluid Ophthalmorrhea: A Rare Case Report. SUNTEXT REVIEW OF PEDIATRIC CARE 2022; 3:129. [PMID: 35262067 PMCID: PMC8900312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background Cerebrospinal fluid (CSF) leak from the nose (rhinorrhea) or the ear (otorrhea) are common with traumatic brain injuries. CSF leak from the orbital roof (ophthalmorrhea) is something rare and warrants further discussion. Case We present a unique case of CSF leak from the orbital roof proceeded by three days history of trauma to the orbit. Discussion Using the clinical case, we discuss unique aspects of the clinical picture, radiological findings of interest, and the surgical procedure for repair.
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Affiliation(s)
- AH Zwayed
- Department of Neurosurgery, Sohar Hospital, Sultanate of Oman, Oman
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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14
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Thirumalai Vasu S, Krishnamoorthy V, Karunakaran S, Pillay HM. A Comparative Analysis Of Transcranial and Endoscopic Repair For Traumatic CSF Rhinorrhoea. J Neurol Surg A Cent Eur Neurosurg 2022. [PMID: 35062035 DOI: 10.1055/a-1747-9744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction
The surgical treatment of anterior cranial base traumatic CSF rhinorrhoea is challenging and is fraught with complications. Whether a person should be offered open craniotomy or endoscopic endonasal repair is a dilemma faced by most surgeons. This study is one of the few to directly compare the two forms of management.
Methods
Data was collected from two groups of 15 patients each who underwent transcranial CSF leak repair and endoscopic endonasal CSF leak repair respectively in a tertiary care hospital over a as a observational study. Information including demographics, recurrence rates, complications and hospital and ICU stay were recorded and analysed. Outcome was assessed up to 6 months.
Results
Recurrence was seen in 9/30 patients, 6 in the transcranial arm and 3 in the endoscopic arm. Hospital stay more than 1 week was present in all transcranially operated patients and only 73% of endoscopically operated patients (p=0.439) although the ICU stay was reduced in the endoscopic arm (p=0.066). Complications were most common with transcranial repair (7 of 8 patients who underwent transcranial repair p=0.035) with anosmia being the most common, (33.3%, p=0.042).
Conclusion
Transcranial open repair is a reasonable choice especially for leaks that occur through the frontal sinus and extend backward into the frontoethmoid region. However, this modality has the drawbacks of greater number of complications, higher recurrence rate, longer ICU and overall hospital stay. The endoscopic endonasal repair enjoys a lower morbidity profile although it may not be an adequate treatment for leaks that are placed far laterally in the frontal sinus.
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Gao W, Wang X, Fang Y, Hong Y, Yan W, Zhang S, Li C. Diagnostic Value of Non-Contrast CT in Cerebrospinal Fluid Leakage After Endoscopic Transnasal Surgery for Sellar and Suprasellar Tumors. Front Oncol 2022; 11:735778. [PMID: 35127466 PMCID: PMC8810488 DOI: 10.3389/fonc.2021.735778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
We aimed to study the relationship between pneumocephalus on non-contrast CT (NCCT) and post-operative cerebrospinal fluid leakage (p-CFL) after endoscopic transsphenoidal sellar and suprasellar tumor surgeries. Data from patients who underwent endoscopic treatment for sellar or suprasellar tumors from January 2018 to March 2020 were consecutively collected and reviewed. The NCCT pneumocephalus (NP) was measured the first day after operation and the first day after the expansive sponge was extracted. p-CFL was determined according to post-operative clinical symptoms, high resolution CT and glucose test, and expert consensus. Of the 253 patients enrolled in this study, 32 (12.6%) had p-CFL. Compared with patients without p-CFL, patients with p-CFL had a higher occurrence of intra-operative CFL, a longer operation time, a higher rate of pneumocephalus on first-day NCCT after operation (i.e., first-day NP), and a higher rate of NP volume change between two NCCT measurements (referred to as the NP change) (all p < 0.05). In multivariate regression analysis, first-day NP was independently associated with p-CFL occurrence [odds ratio (OR)=6.395, 95% confidence interval (CI)=2.236-18.290, p=0.001). After adding the NP change into the regression model, first-day NP was no longer independently associated with p-CFL, and NP change (OR = 19.457, 95% CI = 6.095–62.107, p<0.001) was independently associated with p-CFL. The receiver operating characteristic curve comparison analysis showed that NP change had a significantly better predicting value than first-day NP (area under the curve: 0.988 vs. 0.642, Z=6.451, p=0.001). NP is an effective imaging marker for predicting p-CFL after endoscopic sellar and suprasellar tumors operation, and the NP change has a better predicting value.
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Affiliation(s)
- Wei Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- Department of Neurosurgery, Changxing People’s Hospital, Changxing, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuan Hong
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wei Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Sheng Zhang
- Department of Neurology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
- *Correspondence: Sheng Zhang, ; Chenguang Li,
| | - Chenguang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- *Correspondence: Sheng Zhang, ; Chenguang Li,
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16
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Shao W, Shurin GV, He X, Zeng Z, Shurin MR, Star A. Cerebrospinal Fluid Leak Detection with a Carbon Nanotube-Based Field-Effect Transistor Biosensing Platform. ACS APPLIED MATERIALS & INTERFACES 2022; 14:1684-1691. [PMID: 34932323 DOI: 10.1021/acsami.1c19120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cerebrospinal fluid (CSF) leakage may lead to life-threatening complications if not detected promptly. However, gel electrophoresis, the gold-standard test for confirming CSF leakage by detecting beta2-transferrin (β2-Tf), requires 3-6 h and is labor-intensive. We developed a new β2-Tf detection platform for rapid identification of CSF leakage. The three-step design, which includes two steps of affinity chromatography and a rapid sensing step using a semiconductor-enriched single-walled carbon nanotube field-effect transistor (FET) sensor, circumvented the lack of selectivity that antitransferrin antibody exhibits for transferrin isoforms and markedly shortened the detection time. Furthermore, three different sensing configurations for the FET sensor were investigated for obtaining the optimal β2-Tf sensing results. Finally, body fluid (CSF and serum) tests employing our three-step strategy demonstrated high sensitivity, suggesting its potential to be used as a rapid diagnostic tool for CSF leakage.
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Affiliation(s)
- Wenting Shao
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Galina V Shurin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15260, United States
| | - Xiaoyun He
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Zidao Zeng
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Michael R Shurin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15260, United States
| | - Alexander Star
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
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Chou CH, Huang TH, Hsieh PC, Ho NYJ, Chen CA, Wu K, Tsai TT. Quantitative lateral flow immunoassay for rapid detection and monitoring of cerebrospinal fluid leakage following incidental durotomy. Anal Chim Acta 2022; 1196:339544. [DOI: 10.1016/j.aca.2022.339544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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18
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Lad PB, Ahire P, Tanpure S. Treatment of Ruptured Meningocele Post-Brachial Plexus Surgery: Potential Life-Threatening Complication-An Unique Case Report of Management of Ruptured Meningocele Post-Brachial Plexus Surgery to Avoid Dreadful Complication. J Orthop Case Rep 2021; 11:16-18. [PMID: 34790595 PMCID: PMC8576785 DOI: 10.13107/jocr.2021.v11.i07.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Formation of meningocele in brachial plexus injury is known and can be diagnosed on magnetic resonance imaging (MRI). It is mainly reported in brachial plexus root avulsion injuries and does not require specific treatment. We report accurate diagnosis and management of dreadful complication due to rupture of meningocele post-brachial plexus exploration. Case Report: A 23-year-old engineer presented at 4 months post-bike accident right side extended brachial plexus injury involving C5, C6, and C7. On MRI, he had meningocele in C6-7 root region. We performed supraclavicular exploration of brachial plexus and distal nerve transfers for shoulder abduction and elbow flexion. During surgery, the meningocele was ruptured. As the cyst was deep and extending toward apex of lung, the diagnosis of fluid drained had to be distinguished from pleural fluid with cerebrospinal fluid (CSF). We found hemo-glucose test and beta-2-transferrin levels are mandatory to confirm the diagnosis. Post-surgery, the patient had drainage of almost 500 cc of CSF from wound every day for 3 days. This was managed by repeat MRI and finally lumbar puncture drainage helped to seal the meningocele in neck. Conclusion: Meningocele in brachial plexus injury is common but rupture of cyst can be fatal. To confirm the origin of fluid, beta-2-transferin level is more specific test than the hemo-glucose test. Lumbar puncture and drainage away from neck can be more reliable modality of treatment in case of intraoperative rupture of such cysts if drainage is excessive postoperatively.
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Affiliation(s)
- Parag B Lad
- Department of Orthopaedic, Thane, Maharashtra, India
| | - Pankaj Ahire
- Department of Orthopaedic, Holy Spirit Hospital, Mumbai, Maharashtra, India
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Albaharna H, Alshareef M, Alromaih S, Aloulah M, Alsaleh S, Alroqi A. Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:223-229. [PMID: 34713008 PMCID: PMC8527542 DOI: 10.4274/tao.2021.2021-3-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak. Methods: A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications. Results: After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series. Conclusion: Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.
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Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology-Head and Neck surgery, Qatif Central Hospital, Qatif, Eastern province, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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20
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Endonasal Endoscopic and Hybrid Surgery Techniques for Blunt Trauma Fractures of the Skull Base With Cerebrospinal Fluid Leaks. J Craniofac Surg 2021; 32:2500-2507. [PMID: 34224458 DOI: 10.1097/scs.0000000000007932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Cerebrospinal fluid (CSF) leakage caused by skull base fracture represents high risks of bacterial meningitis, and a rate of mortality of 8.9%. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high rates of success. The aim of this study is to describe our technique for management of skull base CSF leaks secondary to craniofacial trauma based on the anatomic location of the leak. This is a retrospective case series of 17 patients with diagnosis of craniofacial trauma, surgically treated with sole endonasal endoscopic and combined endonasal/transcranial approaches with diagnosis of CSF leak secondary to skull base fractures. Seventeen patients met inclusion criteria for this study. Mean age was 46 years old. Most common etiology was motor vehicle. Early surgery was performed in 8 patients, and late surgery in 9 patients. The most common site of CSF leak was at ethmoid cells or at the fronto-ethmoid junction in 9 patients. Thirteen patients (76.4%) were treated only with endonasal endoscopic technique, and 4 (23.5%) with hybrid surgery, combining endonasal endoscopic and cranial bicoronal approaches with nasal and pericranial vascularized flaps, and nasal mucosal free flaps. Mean hospital stay was 23.7 days.The mean follow-up time was 25.6 months. When surgical reconstruction is indicated for CSF leaks secondary to skull base fractures, endonasal endoscopic techniques should be part of the surgical management either as a sole procedure, or in combination with classical transcranial approaches with high rates of success and low morbidity.
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21
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Ghahvehchian H, Sadrhosseini SM, Fard MA. Pneumocephalus after Orbital Decompression Surgery for Thyroid Eye Disease. Middle East Afr J Ophthalmol 2020; 27:142-144. [PMID: 32874051 PMCID: PMC7442077 DOI: 10.4103/meajo.meajo_170_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 04/19/2020] [Accepted: 06/06/2020] [Indexed: 11/04/2022] Open
Abstract
A cerebrospinal fluid (CSF) leak is a rare complication after orbital surgery. We reported a 49-year-old man who presented with CSF leakage after transcaruncular medial wall decompression for proptosis due to thyroid eye disease. He underwent an endoscopic endonasal approach to surgical repair of the defect with nasoseptal flap. Rhinorrhea was stopped immediately after endoscopic repair.
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Affiliation(s)
- Hossein Ghahvehchian
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Seyyed M Sadrhosseini
- Department of Otolaryngology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Masoud A Fard
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
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22
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Deng W, Liu J, Pang F, Zhang X. Diagnosis and management of pediatric cerebrospinal fluid leakage secondary to inner ear malformations: A report of 13 cases. Int J Pediatr Otorhinolaryngol 2020; 135:110049. [PMID: 32497907 DOI: 10.1016/j.ijporl.2020.110049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Inner ear malformations (IEM) with cerebrospinal fluid (CSF) leakage in children is a rare condition, nevertheless, it may lead to meningitis. Early diagnosis and treatment are crucial. The aims of the study were to summarize the clinical characteristic of pediatric CSF leakage secondary to IEM, and to recommend transcanal endoscopic ear surgery (TEES) as an effective surgical technique for the treatment of CSF leakage with IEM in children. METHODS This was a retrospective study. Thirteen children and fourteen ear surgery were included. Demographics, detail history, laboratory data, Audio test, and imageological examination results were recorded. All the pediatric patients underwent TEES. RESULTS Most (92.31%) of the children presented with a history of rhinorrhea. 69.23% (9/13) of the children had suffered from meningitis, and the other had presented with respiratory tract infections. The follow-up duration ranged from 0.75 years to 5.29 years. Transcanal endoscopic repair of CSF leakage secondary to IEM was the first surgery with a success rate of 92.86% (13 out of 14 cases). A fistula could be found in the stapes footplate in all pediatric patients. CONCLUSION Even if there has been no history of meningitis, the diagnosis of CSF leakage in children suffering from unilateral rhinorrhea and recurrent respiratory tract infection is considered. Auditory brainstem response (ABR) and Temporal bone computed tomography (CT) examinations are suggested to identify IEM. The TEES procedure is recommended in our study as the first choice that repairs CSF leakage secondary to IEM.
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Affiliation(s)
- Wenmin Deng
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Jie Liu
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Feng Pang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
| | - Xiangmin Zhang
- Department of Sleep Breathing Disorder Center and Department of Otorhinolaryngology, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China.
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Abstract
Cerebrospinal fluid (CSF) rhinorrhea refers to the loss of CSF through the nasal cavity. Its causes can be classified as either spontaneous or non-spontaneous. Spontaneous causes of CSF rhinorrhea include congenital anatomical defects and are extremely rare, accounting for less than 4% of reported cases. Following failure of conservative management, definitive treatment most commonly involves an endoscopic transsphenoidal repair of the defect. We present a case of spontaneous CSF rhinorrhea in a previously well 52-year-old female, which required surgical intervention due to failure of conservative management.
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Surgical nuances and placement of subgaleal drains for supratentorial procedures-a prospective analysis of efficacy and outcome in 150 craniotomies. Acta Neurochir (Wien) 2020; 162:729-736. [PMID: 31940095 PMCID: PMC7066100 DOI: 10.1007/s00701-019-04196-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023]
Abstract
Background For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. Method We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. Results Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). Conclusions Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design. Electronic supplementary material The online version of this article (10.1007/s00701-019-04196-6) contains supplementary material, which is available to authorized users.
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25
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S1 guidelines "lumbar puncture and cerebrospinal fluid analysis" (abridged and translated version). Neurol Res Pract 2020; 2:8. [PMID: 33324914 PMCID: PMC7650145 DOI: 10.1186/s42466-020-0051-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits.Recommendations (most important 3-5 recommendations on a glimpse): The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient.Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult.In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF analysis program can be carried out within 2 h.The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy.As a quality assurance measure in CSF analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF analysis. Conclusions In view of the importance and developments in CSF analysis, the S1 guideline "Lumbar puncture and cerebrospinal fluid analysis" was recently prepared by the German Society for CSF analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF (https://www.awmf.org). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.
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26
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Malik R, English J, Hardy TG. Paediatric orbital conjunctival epithelial cyst with positive asialotransferrin. Orbit 2019; 39:426-432. [PMID: 31856620 DOI: 10.1080/01676830.2019.1694044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conjunctival orbital cysts are rare; they are typically either conjunctival dermoid or conjunctival epithelial cysts - congenital or acquired (inclusion). We describe the case of a 15-month-old girl presenting with strabismus and proptosis who had a retrobulbar intraconal cystic lesion displacing the optic nerve, with an adjacent middle cranial fossa anomaly. Aspiration of the orbital cyst tested positive for asialotransferrin, raising the suspicion of a direct communication with cerebrospinal fluid (CSF). Subsequent fine cut CT scanning disproved any connection with the intracranial space, and the cyst was excised complete and intact. Histopathology showed a conjunctival epithelial cyst. To our knowledge, this is the first case report in the literature of an asialotransferrin positive pediatric orbital conjunctival epithelial cyst. It is of clinical relevance as it explores the possibility of either a false positive asialotransferrin or potentially a prior developmental communication with the subarachnoid space. These two diagnostic possibilities are discussed.
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Affiliation(s)
- Rukaiya Malik
- Department of Paediatrics, Sydney Children's Hospital , Randwick, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle , Newcastle, New South Wales, Australia
| | - James English
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital , East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital , East Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Melbourne Hospital , Parkville, Victoria, Australia.,Department of Ophthalmology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne , Parkville, Victoria, Australia
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27
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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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28
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Bradbury DW, Kita AE, Hirota K, St John MA, Kamei DT. Rapid Diagnostic Test Kit for Point-of-Care Cerebrospinal Fluid Leak Detection. SLAS Technol 2019; 25:67-74. [PMID: 31544595 DOI: 10.1177/2472630319877377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cerebrospinal fluid (CSF) leaks can occur when there is communication between the intracranial cavities and the external environment. They are a common and serious complication of numerous procedures in otolaryngology, and if not treated, persistent leaks can increase a patient's risk of developing life-threatening complications such as meningitis. As it is not uncommon for patients to exhibit increased secretions postoperatively, distinguishing normal secretions from those containing CSF can be difficult. Currently, there are no proven, available tests that allow a medical provider concerned about a CSF leak to inexpensively, rapidly, and noninvasively rule out the presence of a leak. The gold standard laboratory-based test requires that a sample be sent to a tertiary site for analysis, where days to weeks may pass before results return. To address this, our group recently developed a semiquantitative, barcode-style lateral-flow immunoassay (LFA) for the quantification of the beta-trace protein, which has been reported to be an indicator of the presence of CSF leaks. In the work presented here, we created a rapid diagnostic test kit composed of our LFA, a collection swab, dilution buffers, disposable pipettes, and instructions. Validation studies demonstrated excellent predictive capabilities of this kit in distinguishing between clinical specimens containing CSF and those that did not. Our diagnostic kit for CSF leak detection can be operated by an untrained user, does not require any external equipment, and can be performed in approximately 20 min, making it well suited for use at the point of care. This kit has the potential to transform patient outcomes.
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Affiliation(s)
- Daniel W Bradbury
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashley E Kita
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kensuke Hirota
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Maie A St John
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA.,Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,UCLA Head and Neck Cancer Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel T Kamei
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Abdelmalik PA, Draghic N, Ling GSF. Management of moderate and severe traumatic brain injury. Transfusion 2019; 59:1529-1538. [PMID: 30980755 DOI: 10.1111/trf.15171] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI-related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI-related disabilities. The cost of care is very high. Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.
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Affiliation(s)
| | - Nicole Draghic
- Department of Clinical Neurosciences, Inova Fairfax Hospital, Falls Church, Virginia
| | - Geoffrey S F Ling
- Department of Clinical Neurosciences, Inova Fairfax Hospital, Falls Church, Virginia.,Neurosciences Critical Care, Departments of Neurology, Neurosurgery and Anesthesiology-Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Oh J, Kwon SJ, Dordick JS, Sonstein WJ, Linhardt RJ, Kim MG. Determination of cerebrospinal fluid leakage by selective deletion of transferrin glycoform using an immunochromatographic assay. Theranostics 2019; 9:4182-4191. [PMID: 31281540 PMCID: PMC6592183 DOI: 10.7150/thno.34411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/13/2019] [Indexed: 12/13/2022] Open
Abstract
Cerebrospinal fluid (CSF) leakage can lead to brain and spine pathologies and there is an urgent need for a rapid diagnostic method for determining CSF leakage. Beta-2 transferrin (β2TF), asialotransferrin, is a specific CSF glycoprotein biomarker used to determine CSF leakage when distinguished from serum sialotransferrin (sTF). Methods: We detected β2TF using an immunochromatographic assay (ICA), which can be potentially developed as a point-of-care (POC) testing platform. Sialic acid-specific lectin selectively captures sTF in multiple deletion lines within an ICA test strip, enabling the detection of β2TF. A sample pre-treatment process efficiently captures excess sTF increasing sensitivity for CSF leakage detection. Results: An optimal cut-off value for determining the presence of CSF in test samples was obtained from receiver operating characteristic (ROC) analysis of the ratio of the test signal intensity and the deletion lines. On 47 clinical samples, ICA test strips discriminated CSF positive from negative samples with statistically significant (positive versus negative t-test; P =0.00027). Additional artificial positive samples, prepared by mixing CSF positive and negative clinical samples, were used as a further challenge. These positive samples were clearly discriminated from the negative samples (mixture versus negative t-test; P =0.00103) and CSF leakage was determined with 97.1% specificity and 96.2% sensitivity. Conclusions: ICA represents a promising approach for POC diagnosis of CSF leakage. While requiring 70 min assay time inconvenient for POC testing, our method was significantly shorter than conventional electrophoresis-based detection methods for β2TF.
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Soundararajan DCR, Shetty AP, Kanna RM, Rajasekaran S. The Effectiveness of Noninvasive Positive Pressure Ventilation in Subarachnoid Pleural Fistula: A Case Report and Literature Review. Neurospine 2018; 15:394-399. [PMID: 30599490 PMCID: PMC6347350 DOI: 10.14245/ns.1836056.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/23/2018] [Indexed: 11/19/2022] Open
Abstract
Subarachnoid pleural fistula (SPF) is an aberrant communication between the pleural cavity and subarachnoid space, resulting in uncontrolled cerebrospinal fluid drainage. The negative pressure of the pleural cavity creates a continuous suctioning effect, thereby impeding the spontaneous closure of these fistulas. Dural tears or punctures in cardiothoracic procedures, spinal operations, and trauma are known to cause such abnormal communications. Failure to recognize this entity may result in sudden neurological or respiratory complications. Hence, a high index of suspicion is required for early diagnosis and prompt management. Noninvasive positive pressure ventilation has been described to be effective in managing such fistulas, thus mitigating the high morbidity associated with exploratory surgery for primary repair. Herein, we describe the typical presentation of SPF and the clinical course, treatment, and follow-up of a patient who sustained SPF following anterior thoracic spinal surgery.
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Affiliation(s)
| | | | | | - S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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32
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Oh JW, Kim SH, Whang K. Traumatic Cerebrospinal Fluid Leak: Diagnosis and Management. Korean J Neurotrauma 2017; 13:63-67. [PMID: 29201836 PMCID: PMC5702760 DOI: 10.13004/kjnt.2017.13.2.63] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/29/2017] [Accepted: 10/08/2017] [Indexed: 11/15/2022] Open
Abstract
Cerebrospinal fluid (CSF) leaks are one of the common complications after traumatic brain injuries (TBI). The risks of CSF leaks can be detrimental to the outcomes of the patients. Early diagnosis and proper management is imperative for it is strongly associated with a better long-term prognosis of the patients. Diagnostic tools for CSF leaks are still under debate. Nevertheless, many reports of successful treatments for CSF leaks have been published with introduction of various repair techniques for leakage sites even though it is surgically challenging. Hereby, we review about the pathophysiology, manifestations as well as the update of the clinical diagnosis and current management of CSF leaks.
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Affiliation(s)
- Ji-Woong Oh
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - So-Hyun Kim
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Kum Whang
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
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Alattar AA, Hirshman BR, McCutcheon BA, Chen CC, Alexander T, Harris J, Carter BS. Risk Factors for Readmission with Cerebrospinal Fluid Leakage Within 30 Days of Vestibular Schwannoma Surgery. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis.
OBJECTIVE
To identify risk factors for and timing of 30-d readmission with CSF leak.
METHODS
Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression.
RESULTS
A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge.
CONCLUSION
This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.
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Affiliation(s)
- Ali A Alattar
- School of Medicine, University of California San Diego, La Jolla, California
| | - Brian R Hirshman
- Division of Neurological Surgery, University of California San Diego, San Diego, California
- Computation, Organization, and Society Program, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Clark C Chen
- Division of Neurological Surgery, University of California San Diego, San Diego, California
| | - Thomas Alexander
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Jeffrey Harris
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
| | - Bob S Carter
- Division of Neurological Surgery, University of California San Diego, San Diego, California
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Baranyi A, Amouzadeh-Ghadikolai O, Lewinski DV, Breitenecker RJ, Stojakovic T, März W, Robier C, Rothenhäusler HB, Mangge H, Meinitzer A. Beta-trace Protein as a new non-invasive immunological Marker for Quinolinic Acid-induced impaired Blood-Brain Barrier Integrity. Sci Rep 2017; 7:43642. [PMID: 28276430 PMCID: PMC5343478 DOI: 10.1038/srep43642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/26/2017] [Indexed: 12/27/2022] Open
Abstract
Quinolinic acid, a macrophage/microglia-derived excitotoxin fulfills a plethora of functions such as neurotoxin, gliotoxin, and proinflammatory mediator, and it alters the integrity and cohesion of the blood-brain barrier in several pathophysiological states. Beta-trace protein (BTP), a monomeric glycoprotein, is known to indicate cerebrospinal fluid leakage. Thus, the prior aim of this study was to investigate whether BTP might non-invasively indicate quinolinic acid-induced impaired blood-brain barrier integrity. The research hypotheses were tested in three subsamples with different states of immune activation (patients with HCV-infection and interferon-α, patients with major depression, and healthy controls). BTP has also been described as a sensitive marker in detecting impaired renal function. Thus, the renal function has been considered. Our study results revealed highest quinolinic acid and highest BTP- levels in the subsample of patients with HCV in comparison with the other subsamples with lower or no immune activation (quinolinic acid: F = 21.027, p < 0.001 [ANOVA]; BTP: F = 6.792, p < 0.01 [ANOVA]). In addition, a two-step hierarchical linear regression model showed that significant predictors of BTP levels are quinolinic acid, glomerular filtration rate and age. The neurotoxin quinolinic acid may impair blood-brain barrier integrity. BTP might be a new non-invasive biomarker to indicate quinolinic acid-induced impaired blood-brain barrier integrity.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.,Institute for International Management Practice, ARU Cambridge, Cambridge, UK
| | | | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert J Breitenecker
- Department of Innovation Management and Entrepreneurship, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Services LLC, Mannheim, Germany.,Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany
| | - Christoph Robier
- Hospital of the Brothers of St. John of God, Graz, Austria.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Hans-Bernd Rothenhäusler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Retrospective validation of a β-trace protein interpretation algorithm for the diagnosis of cerebrospinal fluid leakage. ACTA ACUST UNITED AC 2017; 55:554-560. [DOI: 10.1515/cclm-2016-0442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/29/2016] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Cerebrospinal fluid (CSF) leakage is a rare condition that can potentially lead to the development of serious complications. In the last decade, β-trace protein (β-TP) has been shown to be a valuable immunological biomarker that allows prompt and non-invasive identification of CSF leakage. At our institution, the measurement of β-TP has been included in the diagnostic work-up of CSF leakage for more than 10 years. According to our diagnostic algorithm, the presence of CSF in secretion is excluded when β-TP values are <0.7 mg/L, whereas β-TP values ≥1.3 mg/L indicate the presence of CSF in secretion. β-TP values between 0.7 and 1.29 mg/L indicate the presence of CSF if the β-TP ratio (β-TP secretion/β-TP serum) is ≥2. This study aimed to validate this diagnostic algorithm using clinically defined nasal/ear secretions.
Methods:
We performed a retrospective statistical analysis of three β-TP interpretation strategies using data of 236 samples originating from 121 patients with suspect CSF leakage received at our laboratory between 2004 and 2012.
Results:
The highest odds ratio was obtained when the proposed algorithm has been used for the interpretation of β-TP results, showing a sensitivity of 98.3% and a specificity of 96%. Positive and negative predictive values were 89.2% and 99.4%, respectively.
Conclusions:
Our data suggest that the proposed β-TP interpretation algorithm is a valuable tool for the diagnosis of CSF leakage in the clinical practice.
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Dickkopf-related Protein 3 as a Sensitive and Specific Marker for Cerebrospinal Fluid Leaks. Otol Neurotol 2016; 37:299-303. [PMID: 26837002 DOI: 10.1097/mao.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Cerebrospinal fluid (CSF) can be identified by using an enzyme-linked immunosorbent assay (ELISA) for Dickkopf-related protein 3 (DKK3). BACKGROUND Cerebrospinal fluid leakage from the subarachnoid space is a potentially alarming condition that, left unrepaired, may result in increased risk of meningitis and encephalitis. Current biochemical methods of CSF leak detection involve using beta-2-transferrin-based or beta trace protein-based assays, both of which, at present, have limitations that hinder practical clinical application. This study presents the immunological detection of the CSF-enriched protein DKK3 as a method for detection of a CSF leak. METHODS Antibodies against DKK3 were generated in rabbits and goats immunized with recombinant human DKK3. Varying dilutions and combinations of human CSF and serum were tested on immunoblots and sandwich ELISA using antibodies to DKK3. RESULTS ELISA data show that there is a negligible amount of detectable DKK3 in serum samples compared with CSF samples. Inclusion of sera (up to 30%) in a sample containing CSF failed to produce a positive signal, whereas concentrations of CSF as low as 1% produced a positive signal. The minimum concentration required for reliable CSF detection in a sandwich ELISA was determined to be 0.5 μl. CONCLUSION ELISA sandwich assays for DKK3 can reliably detect the presence of as little as 0.5 μl of human CSF, even in the presence of excessive serum. This study provides quantitative evidence of the utility of DKK3 immunoreactivity as an assay for the presence of CSF in samples that contain contaminating sera. The robustness of this assay has allowed for the development of a rapid, point of care test for the detection of CSF in clinical and surgical setting.
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Patron V, Roger V, Moreau S, Babin E, Hitier M. State of the art of endoscopic frontal sinus cerebrospinal fluid leak repair. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:347-52. [PMID: 26363602 DOI: 10.1016/j.anorl.2015.08.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Frontal sinus cerebrospinal fluid leaks are rare and their surgical management is difficult. Up until recently, they could only be treated by open surgery with an osteoplastic flap. With the development of endoscopic surgery, less invasive techniques such as an exclusive endoscopic approach can now be used, ensuring a simpler postoperative course. However, these techniques require a thorough knowledge of frontal sinus anatomy and endoscopic CSF leak repair. This knowledge is essential both to ensure closure of the CSF leak and to preserve frontal sinus patency.
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Affiliation(s)
- V Patron
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - V Roger
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - S Moreau
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Université de Caen Basse-Normandie, service d'anatomie, 14032 Caen cedex, France
| | - E Babin
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - M Hitier
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Université de Caen Basse-Normandie, service d'anatomie, 14032 Caen cedex, France
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Deseyne S, Vanhouteghem K, Hallaert G, Delanghe J, Malfait T. Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion. Beta-trace protein as a marker for SAPF. Case report and review of the literature. Acta Clin Belg 2015; 70:53-7. [PMID: 25236357 DOI: 10.1179/2295333714y.0000000072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND We describe a case of a 56-year-old woman who developed a recurrent pleural effusion after a thoracoscopic resection of an anterior bulging thoracic disc hernia (level D9-D10). Despite several evacuating pleural punctions, dyspnea reoccurred due to recurrent pleural effusion, the same side as the disc resection. Because of increasing headache after each punction, a subarachnoidal pleural fistula (SAPF) was suspected. Although magnetic resonance imaging (MRI) showed features suggestive of SAPF, there was not enough evidence to justify a new thorascopy. METHODS Cerebrospinal fluid (CSF) leakage into the thoracic and abdominal cavity has been described as a result of trauma or surgery. Detection of beta-trace protein (BTP, a brain-specific protein) has been described to detect CSF fistulae causing rhino- and otoliquorrhea. Similarly, BTP determination could be used to identify the presence of CSF at other anatomical sites such as the thoracic cavity. Therefore, we decided to determine the concentration of BTP in the pleural effusion of this patient. BTP was assayed using immunonephelometry. RESULTS The patient's BTP pleural fluid concentration was 14·0 mg/l, which was a 25-fold increase compared with the BTP serum concentration. After insertion of a subarachnoidal lumbal catheter, a video-assisted thorascopy was performed. Leakage of liquor through the parietal pleura into the thoracic cavity was observed. The SAPF was closed using a durasis patch and DuraSeal®. Postoperatively, there was no reoccurrence of pleural fluid. CONCLUSIONS SAPF has to be included to the differential diagnosis of patients with persistent pleural effusion after spinal surgery. This case illustrates the importance of BTP in diagnosing SAPF, especially in cases where major therapeutic consequences may need to be drawn.
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Affiliation(s)
- S. Deseyne
- Department of Respiratory MedicineGhent University Hospital, Belgium
| | - K. Vanhouteghem
- Department of Laboratory MedicineGhent University Hospital, Belgium
| | - G. Hallaert
- Department of NeurosurgeryGhent University Hospital, Belgium
| | - J. Delanghe
- Department of Laboratory MedicineGhent University Hospital, Belgium
| | - T. Malfait
- Department of Respiratory MedicineGhent University Hospital, Belgium
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Anani WQ, Ojerholm E, Shurin MR. Resolving Transferrin Isoforms via Agarose Gel Electrophoresis. Lab Med 2015; 46:26-33. [DOI: 10.1309/lmvs2jb8jzn8mdvm] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Korem M, Ovadia H, Paldor I, Moses AE, Block C, Eliashar R, Hirshoren N. False negative β-2 transferrin in the diagnosis of cerebrospinal fluid leak in the presence of Streptococcus pneumoniae. Laryngoscope 2014; 125:556-60. [PMID: 25265373 DOI: 10.1002/lary.24940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/07/2014] [Accepted: 08/29/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objectives of this study were to examine the presence of β-2 transferrin (β2TRNSF) in cerebrospinal fluid (CSF) contaminated in vitro by various bacteria and explore the mechanism (passive or active) responsible for β2TRNSF elimination. Early diagnosis of CSF leakage may change treatment decisions and minimize the risk of meningitis and encephalitis. β2TRNSF is a protein present exclusively in CSF. Its detection is highly useful in cases of CSF leakage, although it has never been examined in the presence of central nervous system infection. STUDY DESIGN Prospective patient analysis. METHODS Sterile CSF drawn from patients was contaminated in vitro with several microorganisms chosen for their ability to cause neurosurgical-related infections: Streptococcus pneumoniae, methicillin-sensitive Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. β2TRNSF was examined at two time points: following immediate inoculation (t0) and following an overnight incubation (t18) over various bacterial concentrations. Samples of CSF inoculated with S pneumoniae were also examined in the presence of ciprofloxacin. For β2TRNSF analysis we used immunoblotting electrophoresis and enzyme-linked immunosorbent assay (ELISA). RESULTS CSF samples collected from nine patients were analyzed. β2TRNSF was not detected following S pneumoniae inoculation at both time points when immunoblotting electrophoresis was used. Quantitative analysis using ELISA demonstrated significant β2TRNSF concentration decrease. The addition of ciprofloxacin led to the same results. CONCLUSIONS CSF leak detection using β2TRNSF may be deceiving in the presence of a S pneumoniae cerebral nervous system infection. A passive process is suggested, as β2TRNSF disappeared either immediately or following incubation with inactive bacteria.
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Affiliation(s)
- Maya Korem
- Department of Clinical Microbiology and Infectious Diseases, Hebrew University School of Medicine-Hadassah Medical Center, Jerusalem, Israel
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Lien CH, Chang HY, Liu YP, Chi H, Chiu NC, Lin CY. There is something in the ear: mondini dysplasia. J Pediatr 2014; 165:638-638.e1. [PMID: 24929334 DOI: 10.1016/j.jpeds.2014.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/28/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Chi-Hone Lien
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Peng Liu
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Hasheminia D, Kalantar Motamedi MR, Hashemzehi H, Nazeri R, Movahedian B. A 7-year study of 1,278 patients with maxillofacial trauma and cerebrospinal fluid leak. J Maxillofac Oral Surg 2014; 14:258-62. [PMID: 26028845 DOI: 10.1007/s12663-014-0630-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/21/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran. PATIENTS AND METHODS In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004-2010). Data was obtained using descriptive analysis. RESULTS Of the 1,278 patients with head and maxillofacial fractures, 16 (1.25 %) males and one (0.07 %) female had CSF leak; all these cases had skull base fracture. Of these, 52.9 % had maxillary fracture, 23.5 % nasal fracture, 41.1 % orbital fracture, 11.7 % mandibular fracture, 23.5 % frontal fracture, and 41.1 % had more than one site of fracture. 58.8 % had rhinorrhea and 41.2 % otorrhea. Of all these patients with CSF leak, 8 (47 %), 2 (11.8 %), and 7 (41.2 %) cases were treated spontaneously, using lumbar drain placement, and by surgical intervention, respectively. CONCLUSIONS Cerebrospinal fluid leak was observed most frequently in patients with fracture in the zygomatic and maxillary bone, and mostly exhibited itself as rhinorrhea and/or otorrhea. All cases with CSF leak had skull base fracture as well. However, post-traumatic CSF leaks are uncommon and are generally treated without surgical intervention (59 %). Distribution of CSF leak varies from one region to another and knowing this fact helps to manage the injury and prevent the complications.
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Affiliation(s)
- Dariush Hasheminia
- Department of Oral and Maxillofacial Surgery, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Hezar-Jarib Ave., Isfahan, Iran
| | | | - Hadi Hashemzehi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Rahman Nazeri
- Dental Students Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Movahedian
- Department of Oral and Maxillofacial Surgery, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Hezar-Jarib Ave., Isfahan, Iran
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Choi WH, Moon CT, Koh YC, Chun YI, Cho J, Song SW. Galeal tack-up sutures to prevent subgaleal cerebrospinal fluid collection. J Korean Neurosurg Soc 2013; 54:336-9. [PMID: 24294458 PMCID: PMC3841277 DOI: 10.3340/jkns.2013.54.4.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 12/03/2022] Open
Abstract
Objective Postoperative subgaleal cerebrospinal fluid (CSF) collection is considered as one of the common minor surgical complication which can lead to prolonged hospitalization. We introduce "galeal tack-up suture" to prevent postoperative subgaleal CSF collection. Methods Galeal tack-up suture consists of various surgical techniques which aim to fix galea to cranium in order to prevent CSF pooling in subgaleal space. A total of 87 patients who underwent craniotomy were divided into two groups while closing the wound : group A with galeal tack-up suture and group B with routine wound closure without galeal tack-up suture. The patients were observed for postoperative subgaleal CSF collection. Results Among 87 cranitomy cases, galeal tack-up suture was performed in 32 cases and routine wound closure was done in 55 cases. Postoperative subgaleal CSF collection occurred in 13 cases (15%) in which 12 cases occurred in group B patients and 1 case occurred in group A patients (p=0.026). Conclusion Galeal tack-up suture is an easy and effective technique in wound closure to prevent postoperative CSF collection.
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Affiliation(s)
- Won Ho Choi
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
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Aguilar Cantador J, Jurado-Ramos A, Gutiérrez Jodas J, Müller Locatelli N, Cantillo Baños E, Muñoz Del Castillo F. Non-pedicled vs vascular pedicled nasal flap in repair of cerebrospinal fluid rhinorrhea. Acta Otolaryngol 2012; 132:1192-6. [PMID: 22830607 DOI: 10.3109/00016489.2012.694471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS In our study, pedicled nasal flap (NF) did not provide better results than free nasal graft (NG) for primary closure of cerebrospinal fluid (CSF) rhinorrhea. In the future, a multicenter randomized study would be needed to confirm this result. The choice of surgical technique will depend on the surgeon's experience, and the position and size of the defect. OBJECTIVES To evaluate our results in repairing CSF leaks, comparing the two techniques we used: free NG and pedicled NF. METHODS A total of 33 patients diagnosed with CSF rhinorrhea were operated on between June 2000 and May 2010; 17 were women. The mean age was 44.7 years (± 13.0). Twenty-two (66.6%) NFs of the middle and lower turbinate and septum were performed, the rest being NGs of the middle and lower turbinate only. A descriptive statistical analysis and a Kaplan-Meier survival analysis were carried out and the log-rank statistic was used to compare both techniques. RESULTS In the present study, 78% of defects were closed in all cases; NF was used in 86% (19) and NG in 63.63% (7). The mean follow-up was 71.5 (95% confidence interval (CI), 56.9-86.1) months. There were no statistically significant differences (p > 0.05).
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Affiliation(s)
- J Aguilar Cantador
- Department of Otolaryngology-Head and Neck Surgery, Reina Sofía University Hospital, School of Medicine, University of Cordoba, Spain.
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