xRead - September 2022

Cerebrospinal fluid rhinorrhea diagnosis

FIGURE 1. Proposed evidence-based algorithm for diagnosis of CSF leak. Evidence is insufficient to propose an algorithm for other scenarios which may arise in the diagnosis of CSF leaks. Adapted from Zapalac et al. 24 CSF = cerebrospinal fluid; HRCT = high-resolution computed tomography; MRC = magnetic resonance cisternography.

Conclusion This evidence-based review demonstrates that the best test for confirming the clinical suspicion of a CSF leak is a beta 2 transferrin test. Once the leak is confirmed, it is best localized with a HRCT scan. MRC may be helpful if these other tests are not available or if the results are ambiguous. In a few cases, IF injection may be necessary to localize the leak. The overall level of evidence on this topic is relatively poor. Additional higher-level research is needed to better understand the best diagnostic method for CSF leaks.

Practicing evidence-based medicine entails combining the best available evidence with individual clinical expertise and patient values and expectations. In the case of diag nosis of CSF leaks, the evidence included in this review is unfortunately not terribly robust. This review utilizes the best available evidence, but also points out a significant need for more robust evidence. A large number of level 4 studies have been published in the last decade regarding CSF leak diagnosis. To advance knowledge in this area, additional research involving higher levels of evidence will need to be produced.

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International Forum of Allergy & Rhinology, Vol. 6, No. 1, January 2016

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