RESUMEN
BACKGROUND: After cerebrospinal fluid (CSF) fistula repair, the goal of watertight sealing may not always be achieved, causing postoperative CSF leakage. The aim of this study was to assess the novel application of the beta-trace protein (betaTP) test for postoperative screening and confirmation of dura repair success. METHODS: Prospectively, we investigated 32 consecutive patients who underwent dura repair. Postoperative nasal secretion and serum were analyzed for CSF marker betaTP, to detect or rule out postoperative CSF leakage. RESULTS: In 29 patients no CSF was detected, indicating 91% dura repair success after the first step. Three patients required additional surgery, verifying CSF leak. Additional betaTP testing was negative, revealing successful dura repair. CONCLUSION: Dura repairs should be controlled for the presence or absence of postoperative CSF leakage. In our hands, the sensitive, fast, and inexpensive betaTP test has shown its value as an effective postoperative screening tool for dura repair success confirmation. Therefore, we consider it as novel "standard of care" and reserve invasive, more expensive or time-consuming methods as second choice.
Asunto(s)
Rinorrea de Líquido Cefalorraquídeo/cirugía , Oxidorreductasas Intramoleculares/análisis , Lipocalinas/análisis , Complicaciones Posoperatorias/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Control de Calidad , Transferrina , Resultado del TratamientoRESUMEN
OBJECTIVE: Cerebrospinal fluid (CSF) fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to beta2-transferrin, another CSF protein, beta-trace protein (betaTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new betaTP test for use in routine CSF fistula diagnosis. METHODS: Nephelometric detection of betaTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed. RESULTS: The betaTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the beta2-transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF betaTP values, respectively. CONCLUSION: Quantitative measurement of betaTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with beta2-transferrin test or sodium-fluorescein test.