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Selected Publication:
Sebastnik, D.
The value of β-trace in CSF-leakage detection confirmed by endoscopic Na-Fluorescein evaluation
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2024. pp. 50
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- Authors Med Uni Graz:
- Advisor:
- Andrianakis Alexandros
- Habenbacher Michael
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- Abstract:
- The aim of this thesis is to analyze the diagnostic value of beta-trace protein detection combined with intrathecal sodium-fluorescein evaluation to detect and identify cerebrospinal fluid fistulas of the anterior skull base. A cerebrospinal fluid fistula is defined as a pathological connection between the subarachnoid space (which contains cerebrospinal fluid (CSF)) and adjacent structures, in this thesis the nasal cavity and paranasal sinuses. As a result of the rarity and complexity of this condition as well as the high risk of complications (meningitides), a comprehensive diagnostic protocol is essential for the rapid confirmation and precise localization of fistulas. At the Department of Otolaryngology at the Medical University Graz the combination of testing for beta-trace protein in nasal discharge, radiological imaging (high-resolution computed tomography) and preoperative intrathecal administration of sodium-fluorescein has been the standard diagnostic protocol for many years. This thesis evaluates the accuracy of the beta-trace test in combination with intrathecal sodium-fluorescein administration for detecting cerebrospinal fluid-fistulas. Data was analyzed from patients treated for suspected cerebrospinal fluid fistulas at the Department of Otorhinolaryngology of the Medical University of Graz between January 2010 and December 2020. Before undergoing endoscopic surgery, all patients received a beta-trace test, high-resolution computed tomography and intrathecal sodium-fluorescein administration. For this study, data from a total of 133 cases was collected. After applying the inclusion criteria, 28 patients (9 female, 19 male) between the ages of 8 and 69 years were included. 57.1% of fistulas were of spontaneous origin followed by traumatic fistulas (25%) and iatrogenic fistulas (17.9%). In 67.8% of cases, high-resolution computed tomography detected a bony dehiscence at the anterior skull base. In 75% of cases with a positive beta-trace test, the diagnosis of a CSF fistula was confirmed by the fluorescein test and the fistula was subsequently closed during endoscopic surgery. The intrathecal administration of sodium-fluorescein provided a diagnostic advantage in 57.8% of the cases. No perioperative complications were reported. The combination of testing for beta-trace protein and intrathecal sodium-fluorescein has shown reliable results. However, future research should explore alternatives aiming for non-invasive CSF leak detection protocols.