This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (7)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pathology of Head & Neck  • Alert me on articles by topic  Social Bookmarking   What's this?

Diagnostic Relevance of ₂-Transferrin for the Detection of Cerebrospinal Fluid Fistulas

Athanasia Warnecke, MD; Thomas Averbeck, MD; Ulrich Wurster, PhD; Meike Harmening; Thomas Lenarz, MD, PhD; Timo Stöver, MD

Arch Otolaryngol Head Neck Surg. 2004;130:1178-1184.

Objective  The ₂-transferrin assay is a specific method to identify cerebrospinal fluid (CSF). Hitherto, this test has not been widely used for the routine screening of patients with suspected CSF leakage. The purpose of this study was to investigate the clinical relevance of the identification of ₂-transferrin by comparing the test results with other diagnostic measures and intraoperative findings.

Design  Case series.

Patients  Retrospective analysis of 182 patients tested once or multiple times for ₂-transferrin.

Main Outcome Measures  Information was obtained regarding different diagnostic procedures applied to diagnose CSF leakage. The effectiveness of those diagnostic measures was compared.

Results  The main indication to test for ₂-transferrin was posttraumatic rhinorrhea (25%), followed by spontaneous (22%) and postsurgical (22%) rhinorrhea. In 35 of 205 cases, ₂-transferrin was detected in the tested specimens. Thirteen of these required surgical intervention for treatment of the CSF fistula, and the leakage site was identified in all of them. Taking all results into consideration, the highest correlation was observed between the ₂-transferrin assay, intrathecal fluorescein application, and surgical exploration.

Conclusions  The ₂-transferrin assay is a reliable method for confirming suspected CSF and should be used as a primary screening method in all patients with suspected CSF leakage. Although less invasive, the ₂-transferrin assay almost matches the high sensitivity achieved by exploratory surgery and intrathecal application of fluorescein. However, the possibility of bias should be carefully considered, and in particular, negative results should be critically compared with clinical symptoms and with results from other diagnostic procedures.

From the Departments of Otorhinolaryngology (Drs Warnecke, Averbeck, Wurster, Lenarz, and Stöver and Ms Harmening) and Neurology (Dr Wurster), Medical University of Hannover, Hannover, Germany. The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis
Tebruegge and Curtis
Clin. Microbiol. Rev. 2008;21:519-537.
ABSTRACT | FULL TEXT  

CSF Leaks: Correlation of High-Resolution CT and Multiplanar Reformations with Intraoperative Endoscopic Findings
La Fata et al.
Am. J. Neuroradiol. 2008;29:536-541.
ABSTRACT | FULL TEXT  

Cerebrospinal Fluid Leaks Complicating Orbital or Oculoplastic Surgery
Badilla and Dolman
Arch Ophthalmol 2007;125:1631-1634.
ABSTRACT | FULL TEXT