Determining the Best First-line Modality for Identifying and Localizing Skull Base CSF Leaks

Background: Patients with skull base cerebrospinal fluid (CSF) leaks present headaches, in the ear(s), and/or rhinorrhea, which are vague symptoms. Beta-2-transferrin protein assays gold standard for identifying CSF leaks, but adequate samples cannot always be collected, and results give no specific localizing information. Medical imaging, including Computed Tomography (CT), Magnetic Resonance (MR), Nuclear Medicine (NM) cisternography can utilized to identify localize imperfect tests. This study aims determine best imaging modality by comparing CT, MR, NM Cisternogram beta-2-transferrin assay intraoperative visualization as criterion standards.
 Methods: In this ongoing study, patient cisternogram pre-cisternogram were acquired from electronic medical record, radiology information system, picture archiving communication system. Inclusion criteria include age greater than 18, suspected leak, performed. MR procedure included intrathecal gadolinium SPECT-CT Tc-99m Sulfur Colloid. These data will analyzed positive negative predictive values, sensitivity, specificity, ROC Curve surgical findings.
 Results: From 2018-2022, 30 patients evaluated. limited preliminary set, was more sensitive CT NM, there three false negatives, positives. Performing two types of increased chance leaks. More is needed draw stronger conclusions study.
 Conclusion/Potential Impact: The initial suggests that superior detecting Localizing helps enable surgeons perform less invasive corrective procedures.