Diagnostic Relevance of β2-Transferrin for the Detection of Cerebrospinal Fluid Fistulas

Abstract

The ␤ 2-transferrin assay is a specific method to identify cerebrospinal fluid (CSF). Hitherto, this test has not been widely used for the routine screening of patients with suspected CSF leakage. The purpose of this study was to investigate the clinical relevance of the identification of ␤ 2-transferrin by comparing the test results with other diagnostic measures and intraoperative findings. Design: Case series. Patients: Retrospective analysis of 182 patients tested once or multiple times for ␤ 2-transferrin. Main Outcome Measures: Information was obtained regarding different diagnostic procedures applied to diagnose CSF leakage. The effectiveness of those diagnostic measures was compared. Results: The main indication to test for ␤ 2-transferrin was posttraumatic rhinorrhea (25%), followed by spontaneous (22%) and postsurgical (22%) rhinorrhea. In 35 of 205 cases, ␤ 2-transferrin was detected in the tested specimens. Thirteen of these required surgical intervention for treatment of the CSF fistula, and the leakage site was identified in all of them. Taking all results into consideration, the highest correlation was observed between the ␤ 2-transferrin assay, intrathecal fluorescein application, and surgical exploration. Conclusions: The ␤ 2-transferrin assay is a reliable method for confirming suspected CSF and should be used as a primary screening method in all patients with suspected CSF leakage. Although less invasive, the ␤ 2transferrin assay almost matches the high sensitivity achieved by exploratory surgery and intrathecal application of fluorescein. However, the possibility of bias should be carefully considered, and in particular, negative results should be critically compared with clinical symptoms and with results from other diagnostic procedures.

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

“…In patients with profuse posttraumatic CSF leakage, the diagnosis is obvious and needs only to be confirmed. 115 However, in the acute posttraumatic phase and especially in obtunded patients, the diagnosis could be complicated by the presence of sanguineous fluids exiting from the nasal cavities as the result of other existing facial fractures. Furthermore, it is not rare for CSF rhinorrhea to be intermittent and sometimes start even years after a traumatic event, when that event has been forgotten.…”

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings

“…In this circumstance, beta2-transferrin (␤ 2 -TF) assay provides a highly sensitive and specific (97% and 99%, respectively) method to confirm CSF leak. 4 ␤ 2 -TF protein is found almost exclusively in CSF, and as little as 0.5 mL of CSF is needed for the assay. 3 Once the clinical suspicion of CSF leak is confirmed with ␤ 2 -TF, the skull base defect responsible for the leak must be identified.…”

Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

“…La beta 2 transferrina una muestra debe ser confirmada antes de intentar cualquier opción terapéutica, si es que la historia no orienta a esta sospecha diagnóstica. Una vez confirmada la fístula de LCR ésta debe ser loca-es el método más conveniente por su costo, alta sensibilidad y especificidad en el diagnóstico [16][17] . La beta trace proteína es otro método diagnóstico, siendo más sensible y específica pero con un mayor costo y escasa disponibilidad incluso en USA.…”