Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery

Zhang, Yanyang; Wang, Fuyu; Chen, Xiaolei; Zhang, Zhizhong; Meng, Xunwu; Yu, Xinguang; Zhou, Tao

doi:10.1080/02688697.2016.1199787

Cited by 7 publications

(8 citation statements)

References 28 publications

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“…This makes it difficult to rule in a diagnosis and identify an active site in the context of multiple leaks. 35,41,48…”

Section: Discussionmentioning

confidence: 99%

“…This makes it difficult to rule in a diagnosis and identify an active site in the context of multiple leaks. 35,41,48 MR imaging directly visualizes fistulous tracts without ionizing radiation or interference from bony artifacts. 35 However, the presence of inflammation may cause false positives given its similarly hyperintense signal.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 21 cohort studies 9,11,13,14,17,19,21,25,27,29,31,32,[40][41][42][43][44][45][46][47][48] and 2 case series 6,35 used MRC in 396 patients. The sensitivity and specificity of the cohort studies were 0.94 (0.81-1.00) and 0.77 (0.17-0.97), respectively.…”

Section: Mr Cisternography (Mrc)mentioning

confidence: 99%

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Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Xie

Zhou

Kachra

et al. 2021

Am J Rhinol�Allergy

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Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

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“…This makes it difficult to rule in a diagnosis and identify an active site in the context of multiple leaks. 35,41,48…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Xie

Zhou

Kachra

et al. 2021

Am J Rhinol�Allergy

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“…One‐hundred and fourteen abstracts described HRCT and CSF rhinorrhea; 16 studies reported sensitivities ranging from 43% to 100% . One hundred and twenty‐four abstracts described MRC and CSF rhinorrhea; 18 studies described sensitivities ranging from 65% to 94% . One hundred and eighty‐one abstracts described CTC and CSF rhinorrhea; 10 studies reported sensitivities ranging from 33% to 100% .…”

Section: Methodsmentioning

confidence: 99%

“…8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] One hundred and twenty-four abstracts described MRC and CSF rhinorrhea; 18 studies described sensitivities ranging from 65% to 94%. 8,16,[18][19][20][21][22][23][25][26][27][28][29][30][31][32][33][34] One hundred and eighty-one abstracts described CTC and CSF rhinorrhea; 10 studies reported sensitivities ranging from 33% to 100%. 8,13,18,19,21,22,27,29,35,36 Specific details regarding screened studies and estimated sensitivities are presented in the Appendix.…”

Section: Methodsmentioning

confidence: 99%

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Pool

Patel

Schilling

et al. 2019

Int Forum Allergy Rhinol

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Background The direct costs associated with different diagnostic algorithms to localize cerebrospinal fluid (CSF) rhinorrhea have not been described. Methods A decision‐tree analysis of imaging modalities used to localize CSF rhinorrhea was performed to compare associated direct costs. The primary outcome was cost, which was determined based on reimbursement data published by the Centers for Medicare and Medicaid Services in 2018. The model was parameterized after a literature review of published studies was performed from 1990 to 2018 to estimate the sensitivity CSF rhinorrhea localization of the following radiographic modalities: high‐resolution computed tomography (HRCT), magnetic resonance cisternography (MRC), and CT cisternography (CTC). In addition to base case analysis, 1‐way sensitivity analyses were also performed to evaluate the robustness of results to changes in model parameters. Results Among patients with a high suspicion for CSF rhinorrhea, use of HRCT followed by exploration in the operating room if preliminary HRCT was negative was found to be the optimal localization modality from a cost perspective ($172.25). The next least costly algorithm was HRCT followed by MRC ($294.10). Imaging algorithms beginning with CTC were the next least costly modality ($727.37). Sensitivity analyses generally supported HRCT to be the optimal initial radiographic strategy over a wide range of parameter values. Conclusion This work advocates HRCT as first‐line modality to localize CSF rhinorrhea from a cost perspective. Although algorithms beginning with MRC were on average $35 more expensive than those starting with CTC, associated risks of CTC were not modeled and may play a role in decision making.

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Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Eide,

Mason,

Ray

et al. 2023

Int Forum Allergy Rhinol

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BackgroundBeta‐2 transferrin (B2‐Tf) gel electrophoresis (GE) is the preferred non‐invasive diagnostic modality for confirming cerebrospinal fluid (CSF) in body fluids. While B2‐Tf GE testing is highly sensitive and specific for CSF, false‐positive (FP) and false‐negative (FN) results can lead to diagnostic and therapeutic dilemmas. Several series have demonstrated potential causes of false B2‐Tf GE results, but few studies have reported reasons for these errors. The purpose of this systematic review was to describe sources of B2‐Tf GE errors.MethodsA systematic review was performed by searching OVID, EMBASE, and Web of Science databases for B2‐Tf GE studies. After applying exclusion criteria, original research studies directly addressing erroneous B2‐Tf GE results underwent qualitative analysis.ResultsOf the 243 abstracts screened, 71 underwent full‐text review and 18 studies reporting B2‐Tf GE errors were included for analysis. There were 15 potential FPs, 12 actual FPs, 12 potential FNs, 19 actual FNs, and 14 indeterminate results. There were also 246 potentially indeterminate results from in vitro studies. Reasons for B2‐Tf GE errors included serum transferrin alterations (n = 17; all potential), infection related (n = 13; 9 potential), orbital or salivary contamination (n = 2; 1 potential), and collection related (n = 255; 246 potential). There were 31 false or indeterminate results with unspecified reasons. There were no reported errors due to laboratory processing.ConclusionsMultiple potential or actual reasons for false or indeterminate results have been reported for B2‐Tf GE testing of rhinorrhea and otorrhea. Future studies should explore reasons for B2‐Tf testing errors and how these may affect clinical decision making.

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Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery

Abstract: MR imaging with 3D-SPACE sequence is an effective and reliable method with higher sensitivity and specificity than T2W for detecting CSF leakage. Intraoperative 3D-SPACE image-guided navigation is helpful in locating the sites of the CSF leakage during endonasal endoscopic surgery.

Cited by 7 publications

References 28 publications

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

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