The ß-Trace-Protein (ß-TP) measurement in the diagnosis of cerebrospinal fluid leak – A reliable result?

Introduction:

The measurement of ß-TP for the diagnosis of cerebrospinal fluid (CSF) leak is established as a standard in many clinics. In practice, it is difficult to substantiate CSF leak on the basis of ß-TP values alone.

Methods:

Retrospectively, patients of our clinic with the diagnosis CSF leak were evaluated from 2007 to 2017 with regard to type, cause, therapy, as well as ß-TP concentration and clinical signs of CSF leak. Absorptive sponges were inserted into the nose or ear for ß-TP determination. Values of 0. 35 mg/l in bloodless secretions or double the serum concentration in blood stained secretions were rated as positive. The diagnosis was clinically confirmed if CSF leakage was confirmed endoscopically, intraoperatively, or radiologically. ß-TP values were compared with clinical diagnosis of CSF.

Results:

ß-TP determination was performed in 49 cases. 30 cases were ß-TP positive. In 15 cases ß-TP measurements had to be repeated. Clinical diagnosis of CSF leak was made in 31 cases. 7 patients with oto- and 24 with rhinoliquorrhoea were identified. 31 patients received surgical skull base closure. In 3 cases a negative clinical diagnosis was made despite positive ß-TP concentrations. Conversely, a negative value was measured in 4 cases with a confirmed clinical diagnosis.

Conclusions:

The ß-TP determination is a non-invasive method to diagnose CSF leak. Since the ß-TP value alone is not always reliable, a combination with clinical parameters should be recommended. Further studies are needed to improve CSF leak diagnostics.

Publication History

Publication Date:
23 April 2019 (online)