Retrospective Study of Endoscopic Management of CSF Rhinorrhoea- A Case Series

Vihapure, Ganesh; Agarwal, Ketan; Dokania, Vivek

doi:10.14260/jemds/2017/534

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…[32][33][34][35][36][37][38][39][40][41][42][43] More invasive testing, such as intrathecal injection of radiopaque or radioactive compounds can assist with making CT and MRI diagnosis more accurate; however, it can only confirm the diagnosis when leakage occurs during the time of examination and may fail in cases of intermittent CSF leakage. [20][21][22][23][24][25][26][27][28] Intrathecal administration of fluorescein with surgical exploration may reveal the specific site of leak, but results in the risks associated with anesthesia, and costs associated with mobilization of the surgical suite and the required post-operative care.…”

Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

“…Currently, there are two primary methods of CSF detection in fluids: immunofixation electrophoresis (IFE) and enzyme-linked immunosorbent assay (ELISA). [24][25][26][27][28] IFE relies upon the separations of proteins by their molecular weight, with the β-2 conformation of the transferrin protein traversing farther along an acidic gel than the β-1 conformation. Papadea et al 27 demonstrated consistent IFE results down to 2 μg/mL in patient samples, but this result required a 2.5-hour testing period which is not expedient enough for real time feedback.…”

Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

“…A CSF leak is a serious complication that can result from traumatic, iatrogenic, or spontaneous connection between the intradural and extradural spaces. [22][23][24][25][26] The primary concern related to CSF leaks is meningitis and intracranial infection, which left untreated can be fatal. Common symptoms include headache, nasal drainage, ear drainage, fever, and tinnitus.…”

mentioning

confidence: 99%

“…While imaging studies can often elucidate the site of a leak, the gold standard for detection of CSF is performing an assay for the protein Beta 2 Transferrin (B2T) in nasal secretions or other drainage. [27][28][29][30] While this test results in 99% sensitivity and 97% specificity, [17][18][19][20][21][22][23][24][25][26][27] it generally relies on off-site laboratories with turnaround time on the order of a week for a result. This results in a delay in definitive diagnosis and treatment for patients, especially in the case of spontaneous CSF leaks.…”

mentioning

confidence: 99%

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Review—Opportunities for Rapid, Sensitive Detection of Troponin and Cerebral Spinal Fluid Using Semiconductor Sensors

Carey

Lobo

Gebhard

et al. 2019

J. Electrochem. Soc.

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There are opportunities for development of modularized, inexpensive protein biomarker sensors in clinical applications. In this review we focus on two of these, namely early diagnosis of acute myocardial infarction (AMI) and detection of cerebral spinal fluid (CSF). Evaluation of patients with acute chest pain is challenging due to the heterogeneity of the underlying conditions, leading to patients with AMI being mistakenly sent home from emergency rooms or those at low risk for an adverse cardiac event being unnecessarily admitted without precise cardiac biomarker testing. Cardiac troponin I (cTnI) in cardiac muscle tissue is a standard clinical biomarker for AMI, as its concentration rises quickly in the blood during release from myocardial cells following cell death. The time-dependence of the cTnI concentration is the basis of antigen-antibody methodologies such as radioimmunoassay and enzyme-linked immunosorbent assay (ELISA). These methods are time consuming, leading to delays in diagnosis and higher costs. The challenge is to develop a real-time, accurate, low-cost point-of-care heart attack sensor. The coefficient of variation must be precise, within the parameters established by the American College of Cardiology. Similarly, leakage of cerebrospinal fluid (CSF) is a critical condition with a high risk of meningitis and potential mortality. The primary methods of detection for the biomarker β2-Transfferin (B2T) are immunofixation electrophoresis (IFE) and ELISA. Consistent IFE results down to 2 μg/mL can be obtained in patient samples, but requires a minimum 2.5-hour testing period, which is not expedient for real time feedback during surgery in or around the central nervous system. Additionally, to achieve good sensitivity and handle the inherently low concentration of B2T in CSF, lab procedures require samples to be concentrated or run in duplicate to ensure accurate detection. Real time turnaround is on the order of days. To alleviate the slow turn-around times, there is strong interest in electronic detection methods for proteins using biologically functionalized transistors, which provide an electronic readout and are readily integrated with wireless data transmission.

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Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

Section: Cerebrospinal Fluid Testingmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Review—Opportunities for Rapid, Sensitive Detection of Troponin and Cerebral Spinal Fluid Using Semiconductor Sensors

Carey

Lobo

Gebhard

et al. 2019

J. Electrochem. Soc.

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“…CSF leaks are traditionally detected through collection of the nasal/ear fluid, which undergoes analysis for the protein β-2-transferrin (β2T). [4][5][6][7][8][9][10] The β-2 conformation of transferrin is carbohydrate-free and exclusively found in CSF, not in blood, mucus or tears. It can also be found in patients with perilymph fluid leaks.…”

mentioning

confidence: 99%

Fast Cerebrospinal Fluid Detection Using Inexpensive Modular Packaging with Disposable Testing Strips

Carey

Yang

Ren

et al. 2019

J. Electrochem. Soc.

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This report details the use of a Si Metal Oxide Semiconductor Field Effect Transistor (MOSFET) with the gate connected to a disposable antibody-functionalized electrode for the detection of β-2-transferrin (β2T) as a marker of cerebral spinal fluid (CSF). Through the design of a Si based PCB the need for GaN High Electron Mobility Transistors has been mitigated and brings the cost of production for commercial application closer to realization. Through the use of a double pulse method to the test electrode and the drain of the Si MOSFET, ionicity of the test solution is no longer a concern as a double layer is produced and perturbed on the test electrode giving rise to current changes related to the concentration of the biomarker. Additionally, the PCB provides connections for an oscilloscope readout or an onboard display entirely removing the need for any expensive semiconductor parameter analyzers. Clinically, the cutoff for β2T as indicator of CSF leakage has traditionally been limited to ∼2 μg/mL and takes several hours; with this newly designed board, CSF was detected at levels from 0.1 ng/mL to 100 μg/mL within 5 minutes, greatly improving the detection limits and feedback time for medical professionals.

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