Related Experiment Video
Updated: Sep 28, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery
Gregor Bachmann1, Uta Djenabi, Markus Jungehülsing
1Department of Otorhinolaryngology, University Hospital of Northern Norway, Tromsø, Norway. gregor.bachmann@unn.no
Objective:
To determine the incidence of occult cerebrospinal fluid fistulas after endoscopic paranasal sinus surgery.
Design:
Prospective diagnostic test study with a 6-month follow-up in case of cerebrospinal fluid detection.
Setting:
Tertiary care hospital.
Subjects:
The study population comprised 69 patients undergoing routine endoscopic paranasal sinus surgery. Patients with an obvious intraoperative or postoperative cerebrospinal fluid fistula were not included.
Intervention:
Analysis of 112 samples from intraoperative applied tamponades and of 69 serum samples using a nephelometric research assay for beta-trace protein (prostaglandin D synthase).
Main Outcome Measures:
Incidence of occult cerebrospinal fluid fistula during endoscopic paranasal sinus surgery as indicated with the help of a test for beta-trace protein; at least a 6-month follow-up of patients with an occult cerebrospinal fluid fistula; and relation of occult cerebrospinal fluid fistula with surgical experience of the surgeon.
Results:
Beta-trace protein was found in ethmoid roof samples from 2 patients, giving an incidence of 2.9% for occult cerebrospinal fluid fistula. Both patients were operated on by very experienced surgeons. Signs of a cerebrospinal fluid fistula were not found at follow-up at least 6 months after surgery.
Conclusions:
Nephelometric beta-trace protein assay is a highly sensitive method to detect otherwise unobserved cerebrospinal fluid fistulas. The clinical course of the 2 patients with an occult cerebrospinal fluid fistula indicated the possibility of an uneventful follow-up of patients with small fistulas.