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Gregor Bachmann, MD; Uta Djenabi, CandMed; Markus Jungehülsing, MD; Hela Petereit, MD; Olaf Michel, MD

Arch Otolaryngol Head Neck Surg. 2002;128:1299-1302.

Objective  To determine the incidence of occult cerebrospinal fluid fistulas after endoscopic paranasal sinus surgery.

Design  Prospective diagnostic test study with a 6-month follow-up in case of cerebrospinal fluid detection.

Setting  Tertiary care hospital.

Subjects  The study population comprised 69 patients undergoing routine endoscopic paranasal sinus surgery. Patients with an obvious intraoperative or postoperative cerebrospinal fluid fistula were not included.

Intervention  Analysis of 112 samples from intraoperative applied tamponades and of 69 serum samples using a nephelometric research assay for -trace protein (prostaglandin D synthase).

Main Outcome Measures  Incidence of occult cerebrospinal fluid fistula during endoscopic paranasal sinus surgery as indicated with the help of a test for -trace protein; at least a 6-month follow-up of patients with an occult cerebrospinal fluid fistula; and relation of occult cerebrospinal fluid fistula with surgical experience of the surgeon.

Results  -Trace protein was found in ethmoid roof samples from 2 patients, giving an incidence of 2.9% for occult cerebrospinal fluid fistula. Both patients were operated on by very experienced surgeons. Signs of a cerebrospinal fluid fistula were not found at follow-up at least 6 months after surgery.

Conclusions  Nephelometric -trace protein assay is a highly sensitive method to detect otherwise unobserved cerebrospinal fluid fistulas. The clinical course of the 2 patients with an occult cerebrospinal fluid fistula indicated the possibility of an uneventful follow-up of patients with small fistulas.

From the Department of Otorhinolaryngology, University Hospital of Northern Norway, Tromsø (Dr Bachmann); the Departments of Otorhinolaryngology–Head and Neck Surgery (Ms Djenabi and Dr Michel) and Neurology (Dr Petereit), University of Cologne Medical School, Köln, Germany; and the Department of Otorhinolaryngology, Klinikum "Ernst v. Bergmann," Potsdam, Germany (Dr Jungehülsing).

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