title: Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm.
abstract: OBJECTIVE
  Our goal was to assess the efficacy of current diagnostic modalities in the management of skull base cerebrospinal fluid (CSF) fistulas.
  
  
  METHODS
  We conducted a retrospective review of all patients presenting to our institution over the past 6 years with skull base CSF fistulas.
  
  
  RESULTS
  Fifty-two patients were included in the study. beta2-Transferrin analysis of collected specimen was the most efficacious means of confirming a CSF leak. High-resolution computed tomography was the most informative radiographic study, yielding a sensitivity and an accuracy of 87%. Magnetic resonance cisternography, yielding a sensitivity and an accuracy of 78%, was instrumental in localizing the site of leak for a few cases but was most commonly corroborative. Using a graduated diagnostic approach, successful repair was attained in 88% of cases after 1 attempt and 98% after 1 or 2 attempts.
  
  
  CONCLUSIONS
  For patients with skull base CSF fistulas, a graduated diagnostic approach with emphasis on confirmation of leak by beta2-transferrin analysis and precise localization by high-resolution computed tomography is both efficacious and cost effective.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas 75390, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zapalac
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Marple
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Schwade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome