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Diagnostic Algorithm for Cerebrospinal Fluid Leak

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CSF Rhinorrhea

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Abstract

Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating complication of disruption of the skull base. Identification of rhinorrhea as CSF can be challenging as rhinorrhea, or excess fluid in the nasal cavity, is a common overlapping symptom in inflammatory and infectious rhinopathies. The diagnosis of CSF rhinorrhea requires a comprehensive clinical, laboratory, and radiographic evaluation to: (1) confirm the presence of a CSF leak through the objective evidence of extracranial CSF and (2) identify the position of the skull base defect, or defects, through which the CSF is draining.

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References

  1. Citardi MJ, Fakhri S. Cerebrospinal fluid rhinorrhea. In: Cummings otolaryngology [Internet], vol. 6. Philadelphia: Elsevier Health Sciences; 2015. p. 803–15.

    Google Scholar 

  2. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016;6(1):8–16.

    Article  PubMed  Google Scholar 

  3. Knight A. The differential diagnosis of rhinorrhea. J Allergy Clin Immunol. 1995;95(5 Pt 2):1080–3.

    Article  PubMed  CAS  Google Scholar 

  4. Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007;116(12):902–5.

    Article  PubMed  Google Scholar 

  5. Eljamel MS, Foy PM, Swift AC, MacFarlane IA. Cerebrospinal fluid rhinorrhea occurring in long-term bromocriptine treatment for macroprolactinomas. Surg Neurol. 1992;38(4):321.

    Article  PubMed  CAS  Google Scholar 

  6. Nandapalan V, Watson ID, Swift AC. Beta-2-transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol Allied Sci. 1996;21(3):259–64.

    Article  PubMed  CAS  Google Scholar 

  7. Lund VJ. Endoscopic management of cerebrospinal fluid leaks. Am J Rhinol. 2002;16(1):17–23.

    Article  PubMed  Google Scholar 

  8. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.

    Article  PubMed  Google Scholar 

  9. Hellings PW, Klimek L, Cingi C, Agache I, Akdis C, Bachert C, et al. Non-allergic rhinitis: position paper of the european academy of allergy and clinical immunology. Allergy. 2017;72(11):1657–65.

    Article  PubMed  CAS  Google Scholar 

  10. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352.

    PubMed  PubMed Central  Google Scholar 

  11. Druce HM. Allergic and nonallergic rhinitis. In: Middleton EM, Yunginger JW, Busse WW, editors. Allergy: principles and practice. St. Louis, MO: Mosby Year-Book; 1998. p. 1005–16.

    Google Scholar 

  12. Wang DY, Raza MT, Gordon BR. Control of nasal obstruction in perennial allergic rhinitis. Curr Opin Allergy Clin Immunol. 2004;4(3):165–70.

    Article  PubMed  CAS  Google Scholar 

  13. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147–334.

    Article  PubMed  CAS  Google Scholar 

  14. Torres-Borrego J, Molina-Teran AB, Montes-Mendoza C. Prevalence and associated factors of allergic rhinitis and atopic dermatitis in children. Allergol Immunopathol (Madr). 2008;36(2):90–100.

    Article  CAS  Google Scholar 

  15. Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol. 1999;103(5 Pt 1):773–9.

    Article  PubMed  CAS  Google Scholar 

  16. Nelson HS, Oppenheimer J, Buchmeier A, Kordash TR, Freshwater LL. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol. 1996;97(6):1193–201.

    Article  PubMed  CAS  Google Scholar 

  17. Smart BA. Allergy testing using in vivo and in vitro techniques. Immunol Allergy Clin N Am. 1999;19(1):35–45.

    Article  Google Scholar 

  18. Kim BJ, Mun SK. Objective measurements using the skin prick test in allergic rhinitis. Arch Otolaryngol Head Neck Surg. 2010;136(11):1104–6.

    Article  PubMed  Google Scholar 

  19. Joe SA, Liu JZ. Nonallergic rhinitis. In: Cummings otolaryngology [Internet], vol. 6. Philadelphia: Elsevier Health Sciences; 2015. p. 691–701.

    Google Scholar 

  20. Philip G, Togias AG, Nonallergic rhinitis. Pathophysiology and models for study. Eur Arch Otorhinolaryngol. 1995;252(Suppl 1):S27–32.

    Article  PubMed  Google Scholar 

  21. Georgitis JW. Prevalence and differential diagnosis of chronic rhinitis. Curr Allergy Asthma Rep. 2001;1(3):202–6.

    Article  PubMed  CAS  Google Scholar 

  22. Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23–34.

    PubMed  Google Scholar 

  23. Settipane RA, Kaliner MA. Chapter 14: nonallergic rhinitis. Am J Rhinol Allergy. 2013;27(3):48–51.

    Article  PubMed  Google Scholar 

  24. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobaidi I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1–12.

    Article  PubMed  Google Scholar 

  25. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1–S39.

    PubMed  Google Scholar 

  26. Gautrin D, Desrosiers M, Castano R. Occupational rhinitis. Curr Opin Allergy Clin Immunol. 2006;6(2):77–84.

    PubMed  Google Scholar 

  27. Heederik D, Venables KM, Malmberg P, Hollander A, Karlsson AS, Renstrom A, et al. Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: results from a pooled study. J Allergy Clin Immunol. 1999;103(4):678–84.

    Article  PubMed  CAS  Google Scholar 

  28. Bousquet J, Flahault A, Vandenplas O, Ameille J, Duron JJ, Pecquet C, et al. Natural rubber latex allergy among health care workers: a systematic review of the evidence. J Allergy Clin Immunol. 2006;118(2):447–54.

    Article  PubMed  CAS  Google Scholar 

  29. Gautrin D, Ghezzo H, Infante-Rivard C, Malo JL. Incidence and host determinants of work-related rhinoconjunctivitis in apprentice pastry-makers. Allergy. 2002;57(10):913–8.

    Article  PubMed  CAS  Google Scholar 

  30. Malo JL. Occupational rhinitis and asthma due to metal salts. Allergy. 2005;60(2):138–9.

    Article  PubMed  Google Scholar 

  31. EAACI Task Force on Occupational Rhinitis, Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, et al. Occupational rhinitis. Allergy. 2008;63(8):969–80.

    Article  Google Scholar 

  32. Raphael G, Raphael MH, Kaliner M. Gustatory rhinitis: a syndrome of food-induced rhinorrhea. J Allergy Clin Immunol. 1989;83(1):110–5.

    Article  PubMed  CAS  Google Scholar 

  33. Settipane RA. Other causes of rhinitis: mixed rhinitis, rhinitis medicamentosa, hormonal rhinitis, rhinitis of the elderly, and gustatory rhinitis. Immunol Allergy Clin N Am. 2011;31(3):457–67.

    Article  Google Scholar 

  34. Caparroz FA, Gregorio LL, Bongiovanni G, Izu SC, Kosugi EM. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol. 2016;82(1):105–11.

    Article  PubMed  Google Scholar 

  35. Incaudo GA, Takach P. The diagnosis and treatment of allergic rhinitis during pregnancy and lactation. Immunol Allergy Clin N Am. 2006;26(1):137–54.

    Article  Google Scholar 

  36. Namazy JA, Schatz M. Diagnosing rhinitis during pregnancy. Curr Allergy Asthma Rep. 2014;14(9):458.

    Article  PubMed  Google Scholar 

  37. Varghese M, Glaum MC, Lockey RF. Drug-induced rhinitis. Clin Exp Allergy. 2010;40(3):381–4.

    Article  PubMed  CAS  Google Scholar 

  38. Szczeklik A, Nizankowska E. Clinical features and diagnosis of aspirin induced asthma. Thorax. 2000;55(Suppl 2):S42–4.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Szczeklik A, Sanak M, Niżankowska-Mogilnicka E, Kielbasa B. Aspirin intolerance and the cyclooxygenase-leukotriene pathways. Curr Opin Pulm Med. 2004;10(1):51–6.

    Article  PubMed  CAS  Google Scholar 

  40. Barnes PJ. Neurogenic inflammation in the airways. Respir Physiol. 2001;125(1–2):145–54.

    Article  PubMed  CAS  Google Scholar 

  41. Zucker SM, Barton BM, McCoul ED. Management of rhinitis medicamentosa: a systematic review. Otolaryngol Head Neck Surg. 2019;160(3):429–38.

    Article  PubMed  Google Scholar 

  42. Graf P. Adverse effects of benzalkonium chloride on the nasal mucosa: allergic rhinitis and rhinitis medicamentosa. Clin Ther. 1999;21(10):1749–55.

    Article  PubMed  CAS  Google Scholar 

  43. Mortuaire G, de Gabory L, Francois M, Masse G, Bloch F, Brion N, et al. Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(3):137–44.

    Article  PubMed  CAS  Google Scholar 

  44. Passali D, Salerni L, Passali GC, Passali FM, Bellussi L. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf. 2006;5(6):783–90.

    Article  PubMed  CAS  Google Scholar 

  45. Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med. 2005;4(1):21–9.

    Article  PubMed  CAS  Google Scholar 

  46. Hall LJ, Jackson RT. Effects of alpha and beta adrenergic agonists on nasal blood flow. Ann Otol Rhinol Laryngol. 1968;77(6):1120–30.

    Article  PubMed  CAS  Google Scholar 

  47. Bateman N, Jones NS. Rhinorrhoea feigning cerebrospinal fluid leak: nine illustrative cases. J Laryngol Otol. 2000;114(6):462–4.

    Article  PubMed  CAS  Google Scholar 

  48. Wang SH, Wang HW, Wang JY. Effects of cocaine on human nasal mucosa. Eur Arch Otorhinolaryngol. 1993;250(4):245–8.

    Article  PubMed  CAS  Google Scholar 

  49. Hakansson K, von Buchwald C, Thomsen SF, Thyssen JP, Backer V, Linneberg A. Nonallergic rhinitis and its association with smoking and lower airway disease: a general population study. Am J Rhinol Allergy. 2011;25(1):25–9.

    Article  PubMed  Google Scholar 

  50. Lieberman P. The role of antihistamines in the treatment of vasomotor rhinitis. World Allergy Organ J. 2009;2(8):156–61.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Smith PK, Collins J. Olopatadine 0.6% nasal spray protects from vasomotor challenge in patients with severe vasomotor rhinitis. Am J Rhinol Allergy. 2011;25(4):e149–52.

    Article  PubMed  Google Scholar 

  52. Lieberman P, Meltzer EO, LaForce CF, Darter AL, Tort MJ. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc. 2011;32(2):151–8.

    Article  PubMed  CAS  Google Scholar 

  53. Meltzer EO. The treatment of vasomotor rhinitis with intranasal corticosteroids. World Allergy Organ J. 2009;2(8):166–79.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Naclerio R. Anticholinergic drugs in nonallergic rhinitis. World Allergy Organ J. 2009;2(8):162–5.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Banov CH, Lieberman P, Vasomotor Rhinitis Study Groups. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. Ann Allergy Asthma Immunol. 2001;86(1):28–35.

    Article  PubMed  CAS  Google Scholar 

  56. Gehanno P, Deschamps E, Garay E, Baehre M, Garay RP. Vasomotor rhinitis: clinical efficacy of azelastine nasal spray in comparison with placebo. ORL J Otorhinolaryngol Relat Spec. 2001;63(2):76–81.

    Article  PubMed  CAS  Google Scholar 

  57. Lieberman P, Kaliner MA, Wheeler WJ. Open-label evaluation of azelastine nasal spray in patients with seasonal allergic rhinitis and nonallergic vasomotor rhinitis. Curr Med Res Opin. 2005;21(4):611–8.

    Article  PubMed  CAS  Google Scholar 

  58. van de Heyning PH, van Haesendonck J, Creten W, Rombaut N. Effect of topical levocabastine on allergic and non-allergic perennial rhinitis. A double-blind study, levocabastine vs. placebo, followed by an open, prospective, single-blind study on beclomethasone. Allergy. 1988;43(5):386–91.

    Article  PubMed  Google Scholar 

  59. Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl. 2010;22:1–143.

    PubMed  Google Scholar 

  60. Menasse-Palmer L, Bogdanow A, Marion RW. Choanal atresia. Pediatr Rev. 1995;16(12):475–6.

    Article  PubMed  CAS  Google Scholar 

  61. Samadi DS, Shah UK, Handler SD. Choanal atresia: a twenty-year review of medical comorbidities and surgical outcomes. Laryngoscope. 2003;113(2):254–8.

    Article  PubMed  Google Scholar 

  62. Teissier N, Kaguelidou F, Couloigner V, Francois M, Van Den Abbeele T. Predictive factors for success after transnasal endoscopic treatment of choanal atresia. Arch Otolaryngol Head Neck Surg. 2008;134(1):57–61.

    Article  PubMed  Google Scholar 

  63. Kirtane MV, Gautham K, Upadhyaya SR. Endoscopic CSF rhinorrhea closure: our experience in 267 cases. Otolaryngol Head Neck Surg. 2005;132(2):208–12.

    Article  PubMed  Google Scholar 

  64. Tebruegge M, Curtis N. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev. 2008;21(3):519–37.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Buchanan RJ, Brant A, Marshall LR. Traumatic cerebrospinal fluid fistulas. In: Winn H, editor. Youmans neurological surgery. 5th ed. Philadelphia: Saunders; 2004. p. 5265–72.

    Google Scholar 

  66. Stankiewicz JA, Lal D, Connor M, Welch K. Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience. Laryngoscope. 2011;121(12):2684–701.

    Article  PubMed  Google Scholar 

  67. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol. 2006;115(7):495–500.

    Article  PubMed  Google Scholar 

  68. Badia L, Loughran S, Lund V. Primary spontaneous cerebrospinal fluid rhinorrhea and obesity. Am J Rhinol. 2001;15(2):117–9.

    Article  PubMed  CAS  Google Scholar 

  69. Lay CM. Low cerebrospinal fluid pressure headache. Curr Treat Options Neurol. 2002;4(5):357–63.

    Article  PubMed  Google Scholar 

  70. Mokri B. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache. 2013;53(7):1034–53.

    Article  PubMed  Google Scholar 

  71. Scott S, Davenport R. Low pressure headaches caused by spontaneous intracranial hypotension. BMJ. 2014;349:g6219.

    Article  PubMed  Google Scholar 

  72. Dula DJ, Fales W. The ‘ring sign’: is it a reliable indicator for cerebral spinal fluid? Ann Emerg Med. 1993;22(4):718–20.

    Article  PubMed  CAS  Google Scholar 

  73. Sunder R, Tyler K. Basal skull fracture and the halo sign. CMAJ. 2013;185(5):416.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Meurman OH, Irjala K, Suonpaa J, Laurent B. A new method for the identification of cerebrospinal fluid leakage. Acta Otolaryngol. 1979;87(3–4):366–9.

    Article  PubMed  CAS  Google Scholar 

  75. Oberascher G, Arrer E. Efficiency of various methods of identifying cerebrospinal fluid in Oto- and rhinorrhea. ORL J Otorhinolaryngol Relat Spec. 1986;48(6):320–5.

    Article  PubMed  CAS  Google Scholar 

  76. Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Otolaryngol Head Neck Surg. 2002;126(6):669–76.

    Article  PubMed  Google Scholar 

  77. Marshall AH, Jones NS, Robertson IJ. An algorithm for the management of CSF rhinorrhoea illustrated by 36 cases. Rhinology. 1999;37(4):182–5.

    PubMed  CAS  Google Scholar 

  78. Normansell DE, Stacy EK, Booker CF, Butler TZ. Detection of beta-2 transferrin in otorrhea and rhinorrhea in a routine clinical laboratory setting. Clin Diagn Lab Immunol. 1994;1(1):68–70.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  79. Gorogh T, Rudolph P, Meyer JE, Werner JA, Lippert BM, Maune S. Separation of beta2-transferrin by denaturing gel electrophoresis to detect cerebrospinal fluid in ear and nasal fluids. Clin Chem. 2005;51(9):1704–10.

    Article  PubMed  Google Scholar 

  80. Warnecke A, Averbeck T, Wurster U, Harmening M, Lenarz T, Stover T. Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas. Arch Otolaryngol Head Neck Surg. 2004;130(10):1178–84.

    Article  PubMed  Google Scholar 

  81. Arrer E, Meco C, Oberascher G, Piotrowski W, Albegger K, Patsch W. beta-Trace protein as a marker for cerebrospinal fluid rhinorrhea. Clin Chem. 2002;48(6 Pt 1):939–41.

    Article  PubMed  CAS  Google Scholar 

  82. McCudden CR, Senior BA, Hainsworth S, Oliveira W, Silverman LM, Bruns DE, et al. Evaluation of high resolution gel beta(2)-transferrin for detection of cerebrospinal fluid leak. Clin Chem Lab Med. 2013;51(2):311–5.

    Article  PubMed  CAS  Google Scholar 

  83. Bachmann G, Nekic M, Michel O. Clinical experience with beta-trace protein as a marker for cerebrospinal fluid. Ann Otol Rhinol Laryngol. 2000;109(12 Pt 1):1099–102.

    Article  PubMed  CAS  Google Scholar 

  84. Petereit HF, Bachmann G, Nekic M, Althaus H, Pukrop R. A new nephelometric assay for beta-trace protein (prostaglandin D synthase) as an indicator of liquorrhea. J Neurol Neurosurg Psychiatry. 2001;71(3):347–51.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  85. Schnabel C, Di Martino E, Gilsbach JM, Riediger D, Gressner AM, Kunz D. Comparison of beta2-transferrin and beta-trace protein for detection of cerebrospinal fluid in nasal and ear fluids. Clin Chem. 2004;50(3):661–3.

    Article  PubMed  CAS  Google Scholar 

  86. Chan DT, Poon WS, Ip CP, Chiu PW, goh KY. How useful is glucose detection in diagnosing cerebrospinal fluid leak? The rational use of CT and Beta-2 transferrin assay in detection of cerebrospinal fluid fistula. Asian J Surg. 2004;27(1):39–42.

    Article  PubMed  Google Scholar 

  87. Alobaidi I, Ensenat J, Rioja E, Enriquez K, Viscovich L, de Notaris M, et al. Management of cerebrospinal fluid leaks according to size. Our experience. Acta Otorrinolaringol Esp. 2014;65(3):162–9.

    Google Scholar 

  88. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol. 1998;19(4):633–9.

    PubMed  PubMed Central  CAS  Google Scholar 

  89. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 1999;20(4):706–12.

    PubMed  PubMed Central  CAS  Google Scholar 

  90. Algin O, Hakyemez B, Gokalp G, Ozcan T, Korfali E, Parlak M. The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea. Br J Radiol. 2010;83(987):225–32.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  91. Mostafa BE, Khafagi A. Combined HRCT and MRI in the detection of CSF rhinorrhea. Skull Base. 2004;14(3):157–62. Discussion 62.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Sillers MJ, Morgan CE, el Gammal T. Magnetic resonance cisternography and thin coronal computerized tomography in the evaluation of cerebrospinal fluid rhinorrhea. Am J Rhinol. 1997;11(5):387–92.

    Article  PubMed  CAS  Google Scholar 

  93. Tahir MZ, Khan MB, Bashir MU, Akhtar S, Bari E. Cerebrospinal fluid rhinorrhea: an institutional perspective from Pakistan. Surg Neurol Int. 2011;2:174.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Tuntiyatorn L, Laothamatas J. Evaluation of MR cisternography in diagnosis of cerebrospinal fluid fistula. J Med Assoc Thail. 2004;87(12):1471–6.

    Google Scholar 

  95. Goel G, Ravishankar S, Jayakumar PN, Vasudev MK, Shivshankar JJ, Rose D, et al. Intrathecal gadolinium-enhanced magnetic resonance cisternography in cerebrospinal fluid rhinorrhea: road ahead? J Neurotrauma. 2007;24(10):1570–5.

    Article  PubMed  Google Scholar 

  96. Gupta V, Goyal M, Mishra N, Gaikwad S, Sharma A. MR evaluation of CSF fistulae. Acta Radiol. 1997;38(4 Pt 1):603–9.

    Article  PubMed  CAS  Google Scholar 

  97. Rajeswaran R, Chandrasekharan A, Mohanty S, Murali K, Joseph S. Role of MR cisternography in the diagnosis of cerebrospinal fluid rhinorrhoea with diagnostic nasal endoscopy and surgical correlation. Indian J Radiol Imag. 2006;16(3):315–20.

    Article  Google Scholar 

  98. Eberhardt KE, Hollenbach HP, Deimling M, Tomandl BF, Huk WJ. MR cisternography: a new method for the diagnosis of CSF fistulae. Eur Radiol. 1997;7(9):1485–91.

    Article  PubMed  CAS  Google Scholar 

  99. Ecin G, Oner AY, Tokgoz N, Ucar M, Aykol S, Tali T. T2-weighted vs. intrathecal contrast-enhanced MR cisternography in the evaluation of CSF rhinorrhea. Acta Radiol. 2013;54(6):698–701.

    Article  PubMed  Google Scholar 

  100. El Gammal T, Sobol W, Wadlington VR, Sillers MJ, Crews C, Fisher WS 3rd, et al. Cerebrospinal fluid fistula: detection with MR cisternography. AJNR Am J Neuroradiol. 1998;19(4):627–31.

    PubMed  PubMed Central  Google Scholar 

  101. Ozgen T, Tekkok IH, Cila A, Erzen C. CT cisternography in evaluation of cerebrospinal fluid rhinorrhea. Neuroradiology. 1990;32(6):481–4.

    Article  PubMed  CAS  Google Scholar 

  102. Payne RJ, Frenkiel S, Glikstein R, Mohr G. Role of computed tomographic cisternography in the management of cerebrospinal fluid rhinorrhea. J Otolaryngol. 2003;32(2):93–100.

    Article  PubMed  Google Scholar 

  103. Flynn BM, Butler SP, Quinn RJ, McLaughlin AF, Bautovich GJ, Morris JG. Radionuclide cisternography in the diagnosis and management of cerebrospinal fluid leaks: the test of choice. Med J Aust. 1987;146(2):82–4.

    Article  PubMed  CAS  Google Scholar 

  104. Messerklinger W. Nasal endoscopy: demonstration, localization and differential diagnosis of nasal liquorrhea. HNO. 1972;20(9):268–70.

    PubMed  CAS  Google Scholar 

  105. Stammberger H, Greistorfer K, Wolf G, Luxenberger W. Surgical occlusion of cerebrospinal fistulas of the anterior skull base using intrathecal sodium fluorescein. Laryngo Rhino Otologie. 1997;76(10):595–607.

    Article  PubMed  CAS  Google Scholar 

  106. Wolf G, Greistorfer K, Stammberger H. Endoscopic detection of cerebrospinal fluid fistulas with a fluorescence technique. Report of experiences with over 925 cases. Laryngo Rhino Otologie. 1997;76(10):588–94.

    Article  PubMed  CAS  Google Scholar 

  107. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH. Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery. 2007;61(3 Suppl):161–5. Discussion 5–6.

    PubMed  Google Scholar 

  108. Stammberger H. Special problems. In: Hawke M, editor. Functional endoscopic sinus surgery: the Messerklinger technique. Philadelphia: BC Decker; 1991.

    Google Scholar 

  109. Seth R, Rajasekaran K, Benninger MS, Batra PS. The utility of intrathecal fluorescein in cerebrospinal fluid leak repair. Otolaryngol Head Neck Surg. 2010;143(5):626–32.

    Article  PubMed  Google Scholar 

  110. Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD. Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope. 2004;114(2):266–72.

    Article  PubMed  CAS  Google Scholar 

  111. Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery. 2006;58(4 Suppl 2):ONS-246-56. Discussion ONS-56-7.

    Google Scholar 

  112. Mahaley MS Jr, Odom GL. Complication following intrathecal injection of fluorescein. J Neurosurg. 1966;25(3):298–9.

    Article  PubMed  Google Scholar 

  113. Moseley JI, Carton CA, Stern WE. Spectrum of complications in the use of intrathecal fluorescein. J Neurosurg. 1978;48(5):765–7.

    Article  PubMed  CAS  Google Scholar 

  114. Wallace JD, Weintraub MI, Mattson RH, Rosnagle R. Status epilepticus as a complication of intrathecal fluorescein. Case report. J Neurosurg. 1972;36(5):659–60.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology - Head & Neck Surgery, University of Ottawa - L’Université d’Ottawa, Ottawa, Canada

    Lisa Caulley

  2. Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada

    Lisa Caulley

  3. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    Lisa Caulley

  4. Rhinology, King’s College, London, UK

    Claire Hopkins

  5. ENT Consultant, Guy’s and St Thomas’ Hospitals, London, UK

    Claire Hopkins

  6. Emeritus Professor in Rhinology, UCL, London, UK

    Valerie J. Lund

  7. Honorary ENT Consultant, Royal National Throat, Nose and Ear Hospital, UCLH, London, UK

    Valerie J. Lund

Authors
  1. Lisa Caulley
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  2. Claire Hopkins
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  3. Valerie J. Lund
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Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology, King Fahd Medical City, Riyadh, Saudi Arabia

    Abdulaziz A. AlQahtani

  2. Department of Otorhinolaryngology, University of Insubria, Varese, Varese, Italy

    Paolo Castelnuovo

  3. Department of Otolaryngology, Head and Neck Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA

    Roy Casiano

  4. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ricardo L. Carrau

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Caulley, L., Hopkins, C., Lund, V.J. (2022). Diagnostic Algorithm for Cerebrospinal Fluid Leak. In: AlQahtani, A.A., Castelnuovo, P., Casiano, R., Carrau, R.L. (eds) CSF Rhinorrhea. Springer, Cham. https://doi.org/10.1007/978-3-030-94781-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-94781-1_8

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  • Online ISBN: 978-3-030-94781-1

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