Journal of ISSN: 2379-6359 JOENTR Otolaryngology-ENT Research Case Report Volume 7 Issue 1 - 2017 Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management

Abstract

Laboratory a) CSF analysis of the fluid. b) Glucose concentration is >30 mg/dl. Neither sensitive nor specific [10,11].c) Beta-2 transfer in is the gold standard (sensitivity of 94% to 100%, and specificity of 98% to 100%), unfortunately not available in many centers, needs 5-7 days [10]. ImagingThis can be classified into primary and secondary:Primary (helpful in the detection of most of the leaks) [12]:i. MRI cisternography: heavily T2-weighted, fast spin-echo, fatsaturated sequences. Better in prone position with Valsalva maneuver. FLAIR sequence is very useful in differentiating CSF (change to dark) from sinus secretions (persist whitish) without the need for contrast [13,14]. Intrathecal injection of 0.5 ml of gadopentetate dimeglumine, diluted in 3-5 ml of CSF can be added for more details.ii. HRCT: Can show the bony defect and, if there is, any protruding soft tissue through it, and also accumulating fluid, if any. And in some cases pneumocephalus may be seen. It is sensitivity is 88.25 to 93% [15]. It is less sensitive in detecting the exact AbstractCerebrospinal fluid (CSF) rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials. In this article I tried to collect, summarize and organize the updates on this topic from the English literature, and deliver it in a clinical approach manner with suggested algorithm and clarifying illustration so it can be easily understood by the readers and applied by those who are dealing with such cases. Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management 2/6Copyright: ©2017 Sumaily site of the leak when there are multiple fractures [16].iii. Combination of both HRCT and MRI-cisternography provide higher sensitivity and specificity, but usually it is not cost effective and sometimes its time consuming to wait for both to be ready. So, starting with HRCT is advised [12,13,17]. In)) injection either into the lumbar or suboccipital subdural and nasal pledgets in various highrisk areas. Head scans are acquired 2, 6, 12, and 24 hours. And follow-up scans after 48-or 72-hours. It is useful in the detection of intermittent CSF fluid leaks with sensitivity range of 50 to 100%, and specificity 100%. It is relatively poor in exact localization, therefore it is reserved for complex cases when the diagnosis is in question [24]. d) Nasal endoscopy [25]. The last choice is to explore the nasal cavity and paranasal sinuses via and endoscopic sinus surgery looking for the leak and the defect site. Valsalva maneuver and jugular compression could improve detection rate ( Figure 2). i. Extensive bone defects in the cranial base. Secondaryii. Multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus.iii. Associated intracranial lesions requiring surgery.CSF leak is severe, recurrent, or not amenable to the endoscopic treatment.i. Procedure: up to date, no studies on the types of craniotomy and which type is preferred [31]. For a frontoba...

Diagnostic Accuracy of Combined High-Resolution Computed Tomography and MR Cisternography in Evaluation of CSF Rhinorrhea Patients, Taking Surgical Findings As Gold Standard

“…Another similarly aimed study found the sensitivity of HRCT and enhanced MR as 88% and 100% respectively. 17,18,19 Individual values for each modality were not calculated in our study, as it aimed to delineate the advantage of combination of two modalities over the use of any single one for diagnosis of CSF rhinorrhea.…”