Noga Lipschitz1, J Michael Hazenfield2, Joseph T Breen1,3,4, Ravi N Samy1,3,4. 1. Department of Otolaryngology - Head and Neck Surgery. 2. Department of Radiology, University of Cincinnati College of Medicine. 3. Neurosensory Disorders Center at University of Cincinnati Gardner Neuroscience Institute. 4. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Abstract
PURPOSE OF REVIEW: To summarize the current evidence on the diagnostic evaluation of cranial cerebrospinal fluid (CSF) leaks and encephaloceles, including laboratory testing and imaging studies. RECENT FINDINGS: The most sensitive and specific laboratory tests for CSF leak diagnosis are beta-2-transferrin and beta trace protein assays, the former more commonly used because of availability. Imaging studies used for localization of the leak site include high resolution computed tomography (HRCT) and magnetic resonance cisternography (MRC), often used in combination. Intrathecal contrast administration is reserved for complex cases with prior equivocal test results or for patients with multiple skull base defects to localize the leak site. SUMMARY: Diagnosis of CSF leaks and encephaloceles is aimed at both confirming the leak and localizing the leak site. Future advancements in testing techniques may shorten the diagnostic process, limit the need for invasive testing, and improve the safety of such testing in indicated cases.
PURPOSE OF REVIEW: To summarize the current evidence on the diagnostic evaluation of cranial cerebrospinal fluid (CSF) leaks and encephaloceles, including laboratory testing and imaging studies. RECENT FINDINGS: The most sensitive and specific laboratory tests for CSF leak diagnosis are beta-2-transferrin and beta trace protein assays, the former more commonly used because of availability. Imaging studies used for localization of the leak site include high resolution computed tomography (HRCT) and magnetic resonance cisternography (MRC), often used in combination. Intrathecal contrast administration is reserved for complex cases with prior equivocal test results or for patients with multiple skull base defects to localize the leak site. SUMMARY: Diagnosis of CSF leaks and encephaloceles is aimed at both confirming the leak and localizing the leak site. Future advancements in testing techniques may shorten the diagnostic process, limit the need for invasive testing, and improve the safety of such testing in indicated cases.
Authors: Hussain Albaharna; Mohammad Alshareef; Saud Alromaih; Mohammad Aloulah; Saad Alsaleh; Ahmad Alroqi Journal: Turk Arch Otorhinolaryngol Date: 2021-10-15