[Diagnosis and surgical treatment of liquorrhea]

Liquorrhea caused by cerebrospinal fluid fistula may lead to meningitis and should be treated surgically. The diagnostic approach and the surgery may be difficult and improvements are needed.

We present two cases of liquorrhea. A review of the diagnostic and surgical methods is given.

In both cases the diagnosis was confirmed by detection of beta-trace protein. In one case the surgery was complicated. This patient had a cerebrospinal fluid fistula from the sphenoid sinus. In a third operation, performed with sodium fluorescein dying, the fistula was closed.

Rhinorrhea and meningitis are unspecific signs of a possible cerebrospinal fluid fistula. Beta-trace protein is recommended as a diagnostic marker, because this protein has the highest positive predictive value for the presence of cerebrospinal fluid. High-resolution CT scans are the most helpful imaging technique for determining the leakage site, but this is not conclusive in all cases. Using sodium fluorescein may give better outcomes of surgical interventions.