title: Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery.
abstract: OBJECTIVE
  To determine the incidence of occult cerebrospinal fluid fistulas after endoscopic paranasal sinus surgery.
  
  
  METHODS
  Prospective diagnostic test study with a 6-month follow-up in case of cerebrospinal fluid detection.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Analysis of 112 samples from intraoperative applied tamponades and of 69 serum samples using a nephelometric research assay for beta-trace protein (prostaglandin D synthase).
  
  
  METHODS
  Incidence of occult cerebrospinal fluid fistula during endoscopic paranasal sinus surgery as indicated with the help of a test for beta-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
  Beta-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 beta-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.
authors.affiliation: Department of Otorhinolaryngology, University Hospital of Northern Norway, Tromsø, Norway. gregor.bachmann@unn.no
authors.forename: Gregor
authors.initials: G
authors.lastname: Bachmann
authors.forename: Uta
authors.initials: U
authors.lastname: Djenabi
authors.forename: Markus
authors.initials: M
authors.lastname: Jungehülsing
authors.forename: Hela
authors.initials: H
authors.lastname: Petereit
authors.forename: Olaf
authors.initials: O
authors.lastname: Michel
mesh_terms: D000328:Adult; D017677:Age Distribution; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019746:Intramolecular Oxidoreductases / Q000032:analysis*; D007431:Intraoperative Complications / Q000175:diagnosis*; D054834:Lipocalins; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution
chemical_list: D054834:Lipocalins; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase