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Gregor Bachmannharildstad - One of the best experts on this subject based on the ideXlab platform.
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diagnostic values of beta 2 transferrin and beta trace protein as markers for Cerebrospinal Fluid Fistula
2008Co-Authors: Gregor BachmannharildstadAbstract:Introduction: During recent decades, β 2 -transferrin and β-trace protein (prostaglandin D synthase) have been used as immunological markers for the diagnosis of CSF Fistula. A method for detecting CSF traces should be non invasive, reliable and cheap. Methods: The characteristics of the two immunological markers are described based on own experience and a literature review. PubMed (1966 - 2007) was searched and 39 articles were retrieved from the period 1987 - 2007. Results: The β 2 -transferrin marker showed a high reliability during the last decades using immunofixation or immunoblotting. The performance of β 2 -transferrin assay requires between two and four hours hands-on time in the laboratory depending on the assay. The β-trace protein protein marker showed a high reliability when assayed using immunoelectrophoresis or laser-nephelometry. Laser-nephelomety is automated, non- time consuming, provides quantitative results and last but not least, is cheap. A cut-off point at 1.11 mg/l for β-trace protein gave the best trade-off between high sensitivity and high specificity when including the secretion/ serum ratio. Conclusion: Both β 2 -transferrin and β-trace protein are reliable immunological markers for the detection of CSF traces. High diagnostic accuracy values were found for both β 2 -transferrin and β-trace protein protein.
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diagnostic values of beta 2 transferrin and beta trace protein as markers for Cerebrospinal Fluid Fistula
2008Co-Authors: Gregor BachmannharildstadAbstract:Introduction During recent decades, beta2-transferrin and beta-trace protein (prostaglandin D synthase) have been used as immunological markers for the diagnosis of CSF Fistula. A method for detecting CSF traces should be non invasive, reliable and cheap. Methods The characteristics of the two immunological markers are described based on own experience and a literature review. PubMed (1966-2007) was searched and 39 articles were retrieved from the period 1987-2007. Results The beta2-transferrin marker showed a high reliability during the last decades using immunofixation or immunoblotting. The performance of beta2-transferrin assay requires between two and four hours hands-on time in the laboratory depending on the assay. The beta-trace protein protein marker showed a high reliability when assayed using immunoelectrophoresis or laser-nephelometry. Laser-nephelomety is automated, non- time consuming, provides quantitative results and last but not least, is cheap. A cut-off point at 1.11 mg/l for beta-trace protein gave the best trade-off between high sensitivity and high specificity when including the secretion/serum ratio. Conclusion Both beta2-transferrin and beta-trace protein are reliable immunological markers for the detection of CSF traces. High diagnostic accuracy values were found for both beta2-transferrin and beta-trace protein protein.
Anil Nanda - One of the best experts on this subject based on the ideXlab platform.
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skull base Cerebrospinal Fluid Fistula
2012Co-Authors: John D Day, Anil NandaAbstract:A skull base CSF Fistula occurs when there is a defect at the skull base and the subarachnoid space communicates with the extracranial space. Galen in the 2nd century aD was the first to describe leakage of CSF after cranial trauma.5 The term “rhinorrhea” was coined by Thomson3 while describing spontaneous nasal CSF leaks in patients. There exist a number of constants in neurosurgery with respect to achieving good outcomes for our patients. These include an intimate knowledge of surgical anatomy, meticulous technique to avoid injury to vital tissue, sharp attention to hemostasis, and so forth. This issue of Neurosurgical Focus deals with one of these constants that is paramount in cranial, skull base, and spinal neurosurgery, that is, exclusion of the CSF space from the external environment. Failure to obtain adequate closure, resulting in the loss of CSF and the communication of privileged internal space with the exterior milieu, can have a disastrous influence on the eventual outcome of an otherwise uneventful operation. Techniques to restore or maintain seclusion of the space occupied by CSF around the brain and spinal cord is the subject of this issue. The importance of closing the dural defect was put forward by Grant in 1923.2 Walter Dandy,1 in 1926, published the first report on the surgical repair of CSF rhinorrhea. He used muscle and fascia to close a frontal sinus defect. Using an endoscope in the repair of a skull base defect was proposed by Wigand in 1981.4 In recent years endonasal endoscopic approaches to the cranial base have been particularly in vogue. Therefore, it should come as no surprise that this issue has a particular emphasis on techniques applied in these procedures to achieve satisfactory closure. This aspect of contemporary cranial base surgery has taken advantage of the unique expertise of neurosurgeons and our otorhinolaryngology colleagues. Our ability to traverse the nasoand oropharyngeal spaces to reach the skull base and intracranial compartment has realized significant advancements in the past years. New biological and structural materials as well as innovative vascularized tissue transfer techniques have contributed equally to an enhanced ability to create seals that prevent egress of CSF. The level of facility with these techniques, built on the collective experience of others in our field, is demonstrated in this issue. Treating CSF Fistulas, whether from surgical or accidental trauma, remains a critical clinical and surgical challenge. Our results are certainly not perfect; however, a high standard is reachable with adherence to certain principles and proficiency with contemporary techniques. (http://thejns.org/doi/abs/10.3171/2012.5.FOCUS12164)
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is posttraumatic Cerebrospinal Fluid Fistula a predictor of posttraumatic meningitis a us nationwide inpatient sample database study
2012Co-Authors: Ashish Sonig, Jai Deep Thakur, Prashant Chittiboina, Imad Saeed Khan, Anil NandaAbstract:Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not underg...
George Moynihan - One of the best experts on this subject based on the ideXlab platform.
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Cerebrospinal Fluid Fistula after transtemporal skull base surgery
2001Co-Authors: John P Leonetti, Douglas E Anderson, Sam J Marzo, George MoynihanAbstract:OBJECTIVES: The purpose of this article is to outline our methods for the prevention and management of Cerebrospinal Fluid (CSF) leak after transtemporal skull base surgery.METHODS: A total of 589 patients underwent a variety of transtemporal surgical approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999. The medical records were retrospectively reviewed to identify the tumor histology, size, and location as well as the surgical approach, defect reconstruction technique, and the incidence of postoperative CSF leak.RESULTS: The risk of CSF Fistulae was greatest in utilizing the restrosigmoid approach (8%) and least in those who underwent a translabyrinthine approach (4%). Tumor size had no bearing on the incidence of the CSF leak and the overall incidence of meningitis was 1.0%.CONCLUSION: The proper surgical technique will minimize the risk of CSF leak after transtemporal skull base surgery. Immediate management of CSF Fistulae helped prevent meningitis in t...
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prevention and management of Cerebrospinal Fluid Fistula after transtemporal skull base surgery
2001Co-Authors: John P Leonetti, Douglas E Anderson, Sam J Marzo, George MoynihanAbstract:The incidence of Cerebrospinal Fluid (CSF) Fistula after transtemporal skull base surgery can range from 4% to 19%. The risk of CSF leak may be related to tumor size and location, the extent of the dural defect, and the technical aspects of the wound reconstruction. Prevention of meningitis depends on the early detection and management of CSF leakage. Five hundred eighty-nine patients underwent a variety of transtemporal surgical approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999. The medical records were reviewed retrospectively to identify the tumor histology, size, and location, as well as the surgical approach, defect reconstruction technique, and the incidence of postoperative CSF leak. The risk of CSF Fistulae was greatest in using the retrosigmoid approach (8%) and lowest in those who underwent a translabyrinthine approach (4%). Tumor size had no bearing on the incidence of the CSF leak and the overall incidence of meningitis was 1.0%. This article outlines our institutional objective for the prevention and management of CSF Fistula after transtemporal skull base surgery. Illustrative cases will be presented.
Henry H Bohlman - One of the best experts on this subject based on the ideXlab platform.
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270 THE JOURNAL OF BONE AND JOINT SURGERY Postoperative Cerebrospinal-Fluid Fistula Associated with Erosion of the Dura FINDINGS AFTER ANTERIOR RE5EcrI0N OF OSSIFICATION OF THE POSTERIOR LONGITUDINAL LIGAMENT IN THE CERVICAL SPINE*
2016Co-Authors: D. Smith, M. Minneapolis D. T. Minnesota, Henry H BohlmanAbstract:ABSTRACT: Of twenty-two patients who had had anterior decompression of the spinal canal for ossifica-tion of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a Cerebrospinal-Fluid Fistula developed postoperatively in five, and three had a sec-ond operation to repair the defect in the dura. On the basis of this experience, we recommend use of autoge-nous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safel
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postoperative Cerebrospinal Fluid Fistula associated with erosion of the dura findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine
1992Co-Authors: M D Smith, Michael J Bolesta, M Leventhal, Henry H BohlmanAbstract:Of twenty-two patients who had had anterior decompression of the spinal canal for ossification of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a Cerebrospinal-Fluid Fistula developed postoperatively in five, and three had a second operation to repair the defect in the dura. On the basis of this experience, we recommend use of autogenous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safely possible and use of anti-emetic and antitussive medications to protect the remaining coverings of the spinal cord when the dura is found to be absent adjacent to an ossified portion of the posterior longitudinal ligament in the cervical spine.
Gerhard Oberascher - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Cerebrospinal Fluid Fistula repair sensitive quality control using the beta trace protein test
2007Co-Authors: Cem Meco, Erich Arrer, Gerhard OberascherAbstract:BackgroundAfter Cerebrospinal Fluid (CSF) Fistula repair, the goal of watertight sealing may not always be achieved, causing postoperative CSF leakage. The aim of this study was to assess the novel...
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comprehensive algorithm for skull base dural lesion and Cerebrospinal Fluid Fistula diagnosis
2004Co-Authors: Cem Meco, Gerhard OberascherAbstract:Objectives/Hypothesis: Skull base dural lesions and Cerebrospinal Fluid (CSF) Fistulas are potentially vital conditions whose diagnosis can be challenging. The authors' aim was to compose a comprehensive algorithm that combines the most modern diagnostic tools in easily applicable patterns to indicate a possible dural lesion or CSF Fistula. Study Design: Prospective clinical study. Methods: The authors collected the data of all patients with suspicion of CSF Fistula or dural lesion, or both, between January 1999 and December 2002. Beta–trace protein, β2-transferrin, and endoscopic and laboratory sodium fluorescein tests; high-resolution computed tomography; and magnetic resonance cisternography were used according to the symptoms and etiological factors. The results of the diagnostic tools that were used and intraoperative findings (in case of an operative treatment) were reviewed. Results: From 1999 to 2002, 236 patients were evaluated because of suspicion of dural lesion or CSF Fistula, mostly after head trauma. Pattern I of the algorithm was applied for head trauma in dural lesion or CSF leak assessment, pattern II for postoperative CSF leaks, pattern III for evaluation of spontaneous CSF rhinorrhea, and pattern IV for the assessment of recurrent pneumococcal meningitis related to dural lesions without CSF Fistula. By applying the patterns of this algorithm, a dural lesion or CSF leak that was also confirmed intraoperatively was detected in 48 patients. Conclusion: The four patterns of the new diagnostic algorithm described in the present study enable physicians to reliably clarify suspicions of dural lesions and CSF Fistulas and aim to help them choose the best possible management. Each pattern uses the optimal combination of CSF tests and radiological imaging to reach a synergistic effect for precisely detecting dural lesions or CSF Fistulas. Accordingly, this improves surgical decision-making when necessary.
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beta trace protein text new guidelines for the reliable diagnosis of Cerebrospinal Fluid Fistula
2003Co-Authors: Cem Meco, Erich Arrer, Gerhard Oberascher, Gerhard Moser, Klaus AlbeggerAbstract:Abstract Objective Cerebrospinal Fluid (CSF) Fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to β2-transferrin, another CSF protein, β-trace protein (βTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new βTP test for use in routine CSF Fistula diagnosis. Methods Nephelometric detection of βTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed. Results The βTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the β2-transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF βTP values, respectively. Conclusion Quantitative measurement of βTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with β2-transferrin test or sodium-fluorescein test.