Skull base cerebrospinal fluid fistula: a novel detection method based on two-dimensional electrophoresis.
BACKGROUND
The detection of the presence of cerebrospinal fluid (CSF) in nasal secretions contaminated with blood and mucus remains a challenging clinical problem.


METHODS
A prospective study was conducted from November 1998 to February 2002, including 42 patients. Samples (250 microL) of nasal secretions were analyzed by two-dimensional electrophoresis (2-DE). Plasma, mucus, and CSF were identified by specific proteins markers corresponding to characteristic trains of spots. Intrathecal injection of fluorescein followed by the detection of fluorescein on endoscopic examination of the nasal cavities was considered a positive reference for CSF rhinorrhea.


RESULTS
In all cases of positive fluorescein test, we unambiguously observed the presence of several specific CSF markers onto the 2-DE gels. Conversely, all negative fluorescein tests were associated with the absence of CSF-specific spots.


CONCLUSIONS
Two-DE analyses of biologic fluids of nasal origin should be considered as a reliable diagnostic tool in case of suspicion of CSF leak.
Ricchetti
Alma
A
Rhinology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, 24, rue Micheli-du-Crest 1211 Genève 14, Switzerland. Alma.Ricchetti@hcuge.ch
Burkhard
Pierre R
PR
Rodrigo
Neftali
N
Gamulin
Zdravko
Z
Côte
Mélanie
M
Reverdin
Alain
A
Trussart
Catherine
C
Landis
Basile N
BN
Lacroix
Jean-Silvain
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D002648:Child; D016001:Confidence Intervals; D004586:Electrophoresis / Q000379:methods*; D005260:Female; D005402:Fistula / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D019291:Skull Base