ABSTRACT
CSF rhinorrhoea poses a significant challenge even to most astute and experienced surgeons in its accurate localization and management. The diagnosis of CSF leak is ascertained on proper history, neurologic and otorhinolaryngologic examination, laboratory tests and endoscopic findings supplanted by appropriate radiologic studies. The exact visualization and atraumatic surgical technique using endoscope provides better lighting with magnified view, even in lateral recesses giving an edge over other techniques, thus enhancing the surgical outcome.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Cerebrospinal Fluid Rhinorrhea/surgery , Child , Female , Humans , Nasal Cavity/surgery , Neuroendoscopy/methods , Plastic Surgery Procedures/methods , Sphenoid Sinus/surgeryABSTRACT
Orbito-cranial foreign bodies present a treacherous situation that can escape detection. The only evidence of these foreign bodies may be the entry wound in the form of a small lid laceration. A two-year-old boy presented with right upper lid laceration following a fall two hours back. Analysis of the fluid around the wound revealed a beta-tracer protein (beta-TP) value of 33.5 mg/l suggestive of cerebrospinal fluid (CSF). Three-dimensional computed tomography (CT) scan revealed a foreign body measuring 4.2 cm × 0.8 cm passing from the orbital roof to the frontal lobe. The foreign body tract was explored through the eyelid laceration and a broken pencil was removed followed by dural patch graft. The patient developed no ocular or intracranial complications. Beta-TP, a highly specific marker of CSF is routinely used in screening patients of neurosurgery and otolaryngology with CSF leaks, however, its use has never been reported in ophthalmic literature based on an online PubMed search.
Subject(s)
Brain Injuries/metabolism , Brain Injuries/diagnostic imaging , Cerebrospinal Fluid Rhinorrhea/metabolism , Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Child, Preschool , Eye Foreign Bodies/metabolism , Eye Foreign Bodies/diagnostic imaging , Eye Injuries, Penetrating/metabolism , Eye Injuries, Penetrating/diagnostic imaging , Humans , Intramolecular Oxidoreductases/metabolism , Lipocalins/metabolism , Male , Orbit/injuries , Tomography, X-Ray ComputedABSTRACT
Cerebrospinal fluid [CSF] rhinorrhea results in high morbidity and mortality if left untreated. Surgical intervention is recommended in such cases; however, success is dependent on correct diagnosis and precise localization of leak site. Imaging plays a very essential and indispensable role. Imaging also plays a very important role in identifying the cause of leak and planning surgery. The radiological investigations used in evaluation of CSF rhinorrhea evolved over time from simple tests to very sophisticated and highly accurate procedures. Correct diagnosis and localization of leak depends on proper selection and adequate technique of radiological examinations. Sound knowledge in the current radiological investigations for CSF rhinorrhea, including the yield, indications, contraindications, complications, and selection, is essential for both treating physician and radiologist