Diagnosis of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

Oakley, Gretchen M.; Alt, Jeremiah A.; Schlosser, Rodney J.; Harvey, Richard J.; Orlandi, Richard R.

doi:10.1002/alr.21637

Cited by 135 publications

(176 citation statements)

References 73 publications

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“…This model suggests primary use of HRCT as the lowest cost approach to localize CSF rhinorrhea. Using HRCT as an initial diagnostic modality for CSF rhinorrhea has been previously suggested due to its low cost, high sensitivity, high accuracy, and ability to localize bony defects . Meco and Oberascher identified 87% of leaks with HRCT alone in their study while Stone et al .…”

Section: Discussionmentioning

confidence: 98%

“…The decision tree was informed by work first described by Zapalac et al . and further refined by Oakley et al . The algorithm described by Zapalac et al .…”

Section: Methodsmentioning

confidence: 99%

“…included the use of RNC as a confirmatory test following 2 negative β‐2 transferrin tests. This was later removed by Oakley's group because this test is invasive, expensive ($2800), lower in sensitivity compared to β‐2 transferrin, and often still requires formal localization studies in most clinical situations . As such, we did not include RNC in this study although there are providers who continue to use this test as both a diagnostic and localization modality.…”

Section: Methodsmentioning

confidence: 99%

“…Several authors have proposed diagnostic algorithms for approaching patients with high-suspicion for CSF rhinorrhea. [7][8][9][10] Although these methodologies are clinically sound and account for the sensitivity, specificity, and accuracy of these tests, no study to date has evaluated the expected cost associated with these imaging studies. As a result, this work aimed to determine the economic impact of various radiographic modalities in the management of CSF rhinorrhea.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 98%

“…The decision tree was informed by work first described by Zapalac et al . and further refined by Oakley et al . The algorithm described by Zapalac et al .…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Pool

Patel

Schilling

et al. 2019

Int Forum Allergy Rhinol

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“…Cerebrospinal fluid rhinorrhea (CSFR) is the leakage of cerebrospinal fluid into the nasal cavity and paranasal sinuses through a damaged skull base 1. Frontal sinus CSFR (FS-CSFR) is often caused by the bone defect at the frontal posterior table, thus representing unique challenges for surgical repair.…”

Section: Introductionmentioning

confidence: 99%

Transnasal endoscopic and combined intra–extranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea

Yang

Huang

Wang

et al. 2017

TCRM

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The aim of this study was to summarize and analyze the outcomes of frontal sinus cerebrospinal fluid rhinorrhea (FS-CSFR) treated by transnasal endoscopic and combined intra–extranasal approach. Clinical data on 20 cases of FS-CSFR patients from 2005 to 2013, with emphasis on the postoperative complications, clinical outcomes, and key technology involved in the combined intra–extranasal procedure, were retrospectively reviewed. Among the 20 cases, 12 were treated by combined intra–extranasal procedure; the other eight cases were initially treated by trans-nasal endoscopic approach alone, and five of them (5/8, 62.5%) were successfully treated and three failed. The three failed cases subsequently underwent combined intra–extranasal approach. A total of 15 cases, who received combined procedure, experienced fast recovery, had mild complications, and had no significant facial scars, and no CSFR recurrence was observed. Combined intra–extranasal approach offers advantages in not only overcoming the difficulty of insufficient exposure of defects during transnasal endoscopic procedure but also improving the success rate of repair.

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Editorial

Kern

2016

Int Forum Allergy Rhinol

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Diagnosis of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

Abstract: Despite relatively low levels of evidence, recommendations for the diagnosis and management of CSF rhinorrhea can be made based on the current literature. Higher-level studies are needed to better determine optimal diagnostic and clinical management approaches.

Cited by 135 publications

References 73 publications

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Transnasal endoscopic and combined intra–extranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea

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Diagnosis of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

Abstract: Despite relatively low levels of evidence, recommendations for the diagnosis and management of CSF rhinorrhea can be made based on the current literature. Higher-level studies are needed to better determine optimal diagnostic and clinical management approaches.

Cited by 135 publications

References 73 publications

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Transnasal endoscopic and combined intra&ndash;extranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea

Editorial

Contact Info

Product

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About

Transnasal endoscopic and combined intra–extranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea