Spontaneous Spinal Cerebrospinal Fluid Leak: Review and Management Algorithm

Jones, Michael R.; Shlobin, Nathan A.; Dahdaleh, Nader S.

doi:10.1016/j.wneu.2021.03.115

Cited by 15 publications

(12 citation statements)

References 52 publications

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“…Table 4 shows β-TP concentrations, diagnosis, treatment, and subsequent follow-up. The initial β-TP concentration could not be determined in two samples (8,11) In samples 1, 5, and 18, β-TP concentration after surgical treatment was positive, according to our cut-off point, implying persistence of CSF leak. In these cases, β-TP value became negative after the second surgery.…”

Section: Csf Leak Diagnosis Involvesmentioning

confidence: 64%

“…Non‐traumatic CSF leaks represent 3%–4% of cases and most of them are produced by a non‐congenital defect of the skull base 7 . Spontaneous CSF leaks present low frequency and are associated with obesity and idiopathic intracranial hypertension 3,8 . Persistent CSF leaks can result in chronic headaches and discomfort, as well as in increasing the patient's risk of developing life‐threatening complications like bacterial meningitis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

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Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Almela,

Navarro‐Zaragoza,

Laorden

et al. 2023

Laryngoscope Investig Oto

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ObjectiveTo find an adequate cut‐off point for beta trace protein (β‐TP) in nasal secretion (NS) and validate this diagnostic test with a large sample of patients. Likewise, we evaluated β‐TP test efficacy to confirm the cerebrospinal fluid (CSF) leakage closure after treatment.MethodsWe performed a retrospective analysis with 207 samples from 162 patients with suspected CSF leakage received in the Hospital Universitario Virgen de la Arrixaca between 2010 and 2016. Twenty‐five samples were included in the control group. Samples were obtained from NS through a swab to determine β‐TP using a nephelometry‐based assay. Sensitivity, specificity, and area under the curve (AUC) for β‐TP in NS were assessed using the receiver operator characteristic (ROC) analysis.ResultsUsing imaging techniques, the diagnosis of CSF leak was confirmed in 57 patients (35.19%), while 105 had a negative diagnosis (64.81%). Patients with CSF leakage had significantly higher β‐TP values in NS (16.07 ± 16.94 mg/L, p < .001) than the control group (0.33 ± 0.12 mg/L) and patients without CSF leakage (0.61 ± 2.34 mg/L). Applying a 1 mg/L cut‐off point resulted in 96.5% sensitivity and 97.1% specificity. Positive and negative predictive values (PPV and NPV) at this cut‐off were 94.9% and 98.6%, respectively. Finally, this cut‐off point yields a test efficacy for CSF leak diagnosis of 97% (95% CI 92.9–98.9).ConclusionOur study has established a 1 mg/L β‐TP concentration in NS as a cut‐off point for CSF leakage diagnosis with high sensibility and specificity. These results suggest that β‐TP analysis could be useful to check CSF leak resolution.Level of Evidence4.

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Section: Csf Leak Diagnosis Involvesmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Almela,

Navarro‐Zaragoza,

Laorden

et al. 2023

Laryngoscope Investig Oto

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“…e imaging diagnosis of this type of fistulae can be performed through a CT to locate the site of the bone defect; even though the patient has clear symptoms of a CSF leak, images may be normal so studies with MRI and CT myelography can be extended. [6] In contrast, CSF leaks of traumatic origin usually appear in the first 48 h after the trauma, reporting discharge of a clear fluid from the nose that worsens depending on the patient's position and can be accompanied by aqueous drainage from the ears, salty water postnasal drip, headache, and other trauma-related symptoms such as epistaxis, otorrhagia, or alterations of consciousness. In addition to the images mentioned above (CT, MRI, and CT myelography), other tests can be applied to confirm the presence of CSF leak.…”

Section: Discussionmentioning

confidence: 99%

“…The imaging diagnosis of this type of fistulae can be performed through a CT to locate the site of the bone defect; even though the patient has clear symptoms of a CSF leak, images may be normal so studies with MRI and CT myelography can be extended. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid leak postnasopharyngeal swab for SARS-CoV-2 testing: A case report

Robles

Meza

Garcia

et al. 2022

Surgical Neurology International

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Background: Due to the SARS-CoV-2 virus pandemic and its rapid spread worldwide, an early and effective detection strategy was the nasopharyngeal reverse transcription polymerase swab tests, a procedure still performed today. A relatively safe procedure when done correctly, however, one of the rare complications reported in the literature includes a cerebrospinal fluid (CSF) leak. Case Description: A 69-year-old female patient presented to the emergency department with clear fluid rhinorrhea, clinically diagnosed with a CSF fistula after a SARS-CoV-2 nasopharyngeal swab. Resulting computed tomography and magnetic resonance images did not report any abnormalities; however, persistence of clear fluid rhinorrhea obligated pharmacological treatment without resolution, requiring insertion of a lumbar catheter to achieve clinical resolution. Conclusion: It is essential to train staff to correctly administer nasopharyngeal swabs and thus reduce the rate of complications, as well as early recognition of symptoms and signs of CSF fistula.

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“…At present, it is believed by many clinicians that the use of EBP aims to seal off any potential spinal leakages of CSF. [ 15 ] Yet, the use of EBP appears to be successful in treating patients without any identifiable dural defect,[ 11 ] posing queries toward the underlying pathophysiology of developing SIH.…”

Section: Introductionmentioning

confidence: 99%

Lumbar epidural blood patch: An effective treatment for intracranial hypotension

Leung¹,

Chan²,

Chan³

2022

Surgical Neurology International

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Background: The literature has demonstrated the efficacy of lumbar epidural blood patch (LEBP) in the management of spontaneous intracranial hypotension (SIH). However, the underlying pathophysiology of such management remains unclear. In this study, we aim to evaluate the utility of LEBP injections in the management of SIH and develop a potential management algorithm used in the triage and management of SIH patients. Methods: We retrospectively examined the clinical case notes of 14 patients with SIH (age: 25–69 years) who were managed with LEBP injections during the year of 2016–2021. We evaluated the presenting symptoms of each selected patient and radiological findings as well as treatment outcomes. Our aim is to evaluate the effectiveness of LEBP in the treatment of SIH patients through follow-up clinical and imaging assessment. Results: About 93% of patients describe the presence of headache at presentation, while 43% describe it as being of an orthostatic nature. All patients demonstrated typical findings on magnetic resonance imaging brain. Treatment success assessed through symptomatic improvement and radiological resolution was found in 85% of our patients at a 2-month interval. Conclusion: LEBP injection is an effective method of management in patients with a diagnosis of SIH. It should be considered in all SIH patients irrespective of whether a “dural leak” can be localized through radiological investigations.

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Spontaneous Spinal Cerebrospinal Fluid Leak: Review and Management Algorithm

Cited by 15 publications

References 52 publications

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Cerebrospinal fluid leak postnasopharyngeal swab for SARS-CoV-2 testing: A case report

Lumbar epidural blood patch: An effective treatment for intracranial hypotension

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