Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Rhinology. 2018 Jun 1;56(2):166-171. doi: 10.4193/Rhin17.117.
To determine the incidence of occult cerebrospinal fluid leaks (CSF) after functional endoscopic sinus surgery (FESS) and to evaluate the diagnostic performance of beta2-transferrin in blood-contaminated conditions.
Prospective cohort study.
An analysis of 57 intraoperative samples using hydrogel 6 beta2-transferrin assay after FESS was undertaken. In case of CSF positive samples and continuing rhinorrhea, reanalysis after more than 1 year was conducted. In-vivo analysis of a primary spontaneous CSF leak sample took place to verify difficulties in detecting beta2-transferrin in blood-contaminated settings. Own titrations were performed to evaluate detection limits of CSF by beta2-transferrin and beta-trace protein assays in these settings.
An incidence of 13% for occult CSF leaks after FESS was found. In blood-contaminated conditions, routine beta2-transferrin assays showed low sensitivity. In over 1 year follow-up, all samples were negative for CSF and none of them developed clinical relevant CSF leaks or meningitis.
Occult and clinically irrelevant CSF leaks do occur in a significant proportion of patients during and shortly after FESS. Intra- and postoperatively, routine beta2-transferrin assays show low sensitivity. They should not be used in these settings. The clinical course of patients with occult CSF leaks indicated possibility of an uneventful follow-up.
确定功能性内窥镜鼻窦手术（FESS）后隐性脑脊液漏（CSF）的发生率，并评估血液污染条件下β2-转铁蛋白在诊断中的性能。
前瞻性队列研究。
对 FESS 后使用水凝胶 6β2-转铁蛋白分析进行了 57 例术中样本的分析。如果 CSF 阳性样本和持续的鼻漏，在 1 年以上后进行重新分析。对原发性自发性 CSF 漏样本进行体内分析，以验证在血液污染环境中检测β2-转铁蛋白的困难。进行了自身滴定，以评估在这些环境中 CSF 通过β2-转铁蛋白和β-微量蛋白分析的检测限。
发现 FESS 后隐性 CSF 漏的发生率为 13%。在血液污染的情况下，常规β2-转铁蛋白检测显示出较低的灵敏度。在 1 年以上的随访中，所有样本均为 CSF 阴性，且均未发生临床相关的 CSF 漏或脑膜炎。
在 FESS 期间和之后，相当一部分患者会发生隐性和无临床意义的 CSF 漏。术中及术后，常规β2-转铁蛋白检测显示出较低的灵敏度。在这些情况下不应使用它们。隐性 CSF 漏患者的临床过程表明可以进行无并发症的随访。
