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. 2022 May;36(3):397-406.
doi: 10.1177/19458924211060918. Epub 2021 Nov 30.

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Michael Xie  1 , Kelvin Zhou  1 , Shamez Kachra  2 , Tobial McHugh  1 , Doron D Sommer  1
Affiliations

Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea: A Systematic Review

Michael Xie et al. Am J Rhinol Allergy. 2022 May.

Abstract

Background: Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics.

Objective: This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea.

Methods: A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Our search identified 4039 articles-53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed.

Conclusion: MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

Keywords: cerebrospinal fluid leak; diagnostic imaging; preoperative localization; rhinorrhea; skull base defect.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) flow diagram.
Figure 2.
Figure 2.
Cerebrospinal fluid (CSF) etiology demographics.
Figure 3.
Figure 3.
Cerebrospinal fluid (CSF) leak site demographics.
Figure 4.
Figure 4.
Risk of bias and applicability concerns.
See this image and copyright information in PMC

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