Efficacy of Duraplasty: Beta-Trace Protein Test for CSF Fistula Repair Control

Objective: Skull base dura lesions and cerebrospinal fluid (CSF) fistulas could cause life-threatening complications such as meningitis if they are not properly diagnosed and treated. A number of different approaches could be applied for surgical closure of the dural defect. Even the most recently favored intranasal endoscopic closure could not achieve a watertight sealing in all cases. These failed cases require further management, which can only be provided after reliable detection of CSF. Otherwise those cases would still face the same risks as they did before surgery. In this study our aim is to demonstrate the significance of reliable postoperative screening and to assess the novel application of beta-trace-protein (ßTP) test for confirmation of successful dura repair.

Material and Method: Between July 2001 and July 2004, 36 consecutive patients in a tertiary hospital setting underwent duraplasty for various dura lesions caused by different etiologies. In a prospective manner their postoperative nasal secretion was collected at days 3 and 7 after the removal of surgical packing. Together with the patient's serum, samples were analyzed for CSF marker βTP to detect or rule out postoperative CSF leakage.

Results: βTP test results demonstrated that in 33 patients no CSF was detectable in the nasal secretion, indicating 91.7% dura repair success after the first step. Three patients required additional surgery, in which CSF leaks were verified intraoperatively. Two of them initially had anterior skull base tumors with large dural involvement resulting in substantial dura defects and the third had a skull base fracture after head trauma. After revision surgeries, further βTP testing was negative, revealing successful dura repair.

Conclusion: Regardless of the selected approach, duraplasty does not always assure watertight sealing in all cases. Hence, dura repairs should be controlled for the presence or absence of postoperative CSF leakage. In our hands, the sensitive, fast, and inexpensive βTP test has shown its value as an effective postoperative screening tool for dura repair success confirmation. Therefore, we consider this test as the novel “standard of care” for screening after dura repairs and reserve invasive, more expensive, or time-consuming methods as a second choice.