RESUMO
BACKGROUND: Cerebrospinal fluid (CSF) leak of the anterior skull base is an abnormal communication between the subarachnoid space and the nasal cavity or the paranasal sinus. Its presence increases the incidence of complications, as meningitis, with risk of sequelae. The early and correct diagnosis of the CSF leaks is important to perform surgical treatment as soon as possible. The CSF detection in nasal fluids could be made through the beta2-transferrin (beta2Tr) immunoelectrophoretic test, an expensive and cumbersome immunologic test, not available to the majority of the Brazilian hospitals. Recently, the detection of beta-trace protein (betaTP) for identification of CSF leaks has been described. The literature suggests there may be similar sensitivity and specificity to tests of beta2Tr, because betaTP is also a specific brain protein and it is present in CSF in high concentrations. The majority of Brazilian hospitals have the nephelometric equipment for betaTP detection. This study was designed to determine threshold values for betaTP concentrations in nasal cavity secretions as a predictor of CFS leak. METHODS: Nasal secretions were collected from patients with suspicion of CSF leak and from healthy volunteers. Pure CSF samples were used. A nephelometric assay was used to determine the betaTP concentration in samples. RESULTS: Values between 0.244 and 0.496 mg/L were determined for the cutoff. CONCLUSION: Beta-trace concentrations above 0.496 mg/L are highly suggestive of the presence of CSF in examined nasal secretion. Positive predictive value and negative predictive value were 100%. BetaTP nephelometric test can predict the side of the CSF leak.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Oxirredutases Intramoleculares/análise , Lipocalinas/análise , Líquido da Lavagem Nasal/química , Nefelometria e Turbidimetria , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Grupos Controle , Diagnóstico Precoce , Humanos , Oxirredutases Intramoleculares/normas , Lipocalinas/normas , Valor Preditivo dos Testes , Padrões de Referência , Sensibilidade e Especificidade , Transferrina/análise , Transferrina/normasRESUMO
A CSF leak results from a defect in the dura and skull base. Due to the risk of potentially devastating central nervous system infection, it is an important entity. Timely diagnosis of CSF leaks is crucial. Laboratory testing of nasal or aural fluid drainage for the presence of the protein Beta(β)-2 transferrin plays a key role in establishing the presence of a CSF leak. Such assays are not always available, making imaging pivotal in the diagnosis of this entity. The development of minimally invasive endoscopic repair further underscores the importance of imaging as precise anatomic localization is important for repair. In this article, we review the literature and make suggestions for the appropriate radiological investigation ofpatients with suspected CSF leaks.
Las pérdidas de fluido cerebroespinal (FCE) son el resultado de un defecto en la dura y la base craneal. Debido a que tales pérdidas presentan el riesgo de infecciones capaces de devastar potencialmente el sistema nervioso central, las mismas constituyen una entidad importante. El diagnóstico a tiempo de pérdidas del FCE es crucial. Las pruebas de laboratorio realizadas al drenaje del fluido de la nariz y los oídos a fin de detectar la proteína Beta (β) 2 transferrina, desempeñan un papel clave a la hora de determinar la presencia de pérdida de FCE. Estos ensayos no se hallan siempre a disposición, con lo cual la imagen médica se hace fundamental para el diagnóstico de esta entidad. El desarrollo de reparaciones endoscópicas mínimamente invasivas subraya aún más la importancia de la imagen médica, por cuanto se requiere una localización anatómica precisa para realizar la reparación. En el presente artículo, se revisa la literatura y se hacen sugerencias a fin de lograr una investigación radiológica adecuada de los pacientes con sospecha de pérdida de FCE.
Assuntos
Humanos , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Algoritmos , Otorreia de Líquido Cefalorraquidiano/fisiopatologia , Otorreia de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
A CSF leak results from a defect in the dura and skull base. Due to the risk of potentially devastating central nervous system infection, it is an important entity. Timely diagnosis of CSF leaks is crucial. Laboratory testing of nasal or aural fluid drainage for the presence of the protein Beta (beta)-2 transferrin plays a key role in establishing the presence of a CSF leak. Such assays are not always available, making imaging pivotal in the diagnosis of this entity. The development of minimally invasive endoscopic repair further underscores the importance of imaging as precise anatomic localization is important for repair In this article, we review the literature and make suggestions for the appropriate radiological investigation of patients with suspected CSF leaks.
Assuntos
Otorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Algoritmos , Otorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Otorreia de Líquido Cefalorraquidiano/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Different techniques have already been described for reconstructing the sellar floor after transsphenoidal (TS) procedures. This paper reports on the use of fibrin glue alone without grafting or the use of implants in the reconstruction of the sellar floor after TS. METHODS: Five hundred sixty-seven patients who submitted to TS for pituitary and sellar region tumors were studied. No intraoperative cerebrospinal fluid (CSF) leak occurred in 503 patients (group 1); in the remaining 64 patients (group 2), intraoperative CSF leak was noted. In group 1 patients, closure of the sellar floor consisted of packing the surgical bed with hemostatic material only. When CSF leak was noted, the surgical bed was covered with a layer of hemostatic material and the intrasellar space was filled up with fibrin glue. An additional layer of hemostatic material was added at the topography of the preexisting sellar floor, and a second amount of fibrin glue was applied over it. At the end of surgery, a continuous lumbar CSF drainage system was installed in group 2 patients and kept for 5 days. Prophylactic antibiotics were administered during this period. RESULTS: We did not observe delayed CSF leak, meningitis, or visual loss in group 1 patients. In group 2, 2 patients presented with complications: 1 patient got meningitis but no overt CSF leak, and the other disclosed a delayed postoperative leak treated by reoperation. DISCUSSION: Our results showed that closure of the sellar floor with hemostatic material and fibrin glue without grafting or the use of implants is a safe and efficient method to prevent postoperative complications after TS. Generally speaking, there is no need for grafting or the use of implants at the end of TS.
Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Sela Túrcica/cirurgia , Osso Esfenoide/cirurgia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano/prevenção & controle , Derivações do Líquido Cefalorraquidiano/normas , Derivações do Líquido Cefalorraquidiano/estatística & dados numéricos , Seguimentos , Humanos , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/etiologia , Meningites Bacterianas/prevenção & controle , Procedimentos Neurocirúrgicos/instrumentação , Hipófise/anatomia & histologia , Hipófise/patologia , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/instrumentação , Reoperação/estatística & dados numéricos , Sela Túrcica/anatomia & histologia , Sela Túrcica/patologia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/patologia , Transplantes/estatística & dados numéricos , Resultado do TratamentoRESUMO
A rinite alérgica representa uma das doenças mais freqüentes na prática diária do alergologista, otorrinolaringologista e do clínico, caracterizando-se clinicamente por espirros mültiplos, coriza hialina, prurido e obstruçäo nasais. A fístula liquórica, mesmo sendo pouco freqüente, é diagnóstico diferencial importante das rinites. Nesta revisäo procuramos abordar, de forma sucinta, características clínicas, fisiopatologia, diagnóstico laboratorial e tratamento da entidade.
Assuntos
Humanos , Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Fístula/diagnóstico , Rinite/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Diagnóstico Diferencial , Fístula/fisiopatologia , Fístula/cirurgiaRESUMO
Se presentan 4 casos clínicos con esta patología, en pacientes de más de 40 años, de predominio en el sexo femenino, cuyos síntomas principales fueron rinorrea y cefalea. El origen de esta entidad puede ser post traumática, post quirúrgica o espontánea. La rinorrea de líquido cefalorraquideo es una enfermedad poco frecuente en nuestro medio y cuando se diagnostica debe ser tratada en forma multidisciplinaria.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Rinorreia de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/classificação , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , MielografiaRESUMO
Non-traumatic C.S.F. rhinorrhea resulting from hypertensive obstructive hydrocephalus due to an intracranial tumor may constitute the presenting symptom of these affections. The authors report one case of intermittent and positional spontaneous rhinorrhea which was the only sign of a tumor in the pineal region. According to the literature and on the basis of Ommaya's classification of spontaneous rhinorrhea, we emphasize the need to distinguish between ventricular and arachnoid C.S.F leak. This different origins will determine the appropriate (ventricular or lumbar) C.S.F. shunt.