What are the advances in the diagnosis of CSF leak?

Intrathecal dyes combined with endoscopic techniques

Historically used dyes are:

  • methylene blue
  • Indigo carmine
  • Radioactive labelled markers

Messerklinger combined intrathecal fluoreceins in mixed c 10 ml of CFS from a routine lumbar puncture.

This mixture is introduce via a polymed point spinal needle and the patient is placed in the Tredelenberg position for approximately 1 hours.

The nose is spread with a topical anaesthetic and vasoconstrictior (4% lignocaine c 1:1000 Adrenaline) and the endoscopic examination can begin after a minute using a 4mm 30º endoscope .

Positive if flurescein can been seen coming from the defect.

Use blue filter increase the ease of detection(+ve : up to 1:10 million dilution)

If CSF leak into the nasopharynx from the ET orifice specially during swallowing → lateral skull bad

If negative Place merocel sponges in the none for 6 hours and examine ↓blue light.

complication are (usually due to higher those than recommended)

  1. Knee and ankle clonus
  2. seizues
  3. Opisthotonus
  4. Cranial Nerve deficit

previous spinal surgery.

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