Efficacy of Cerebrospinal Fluid Fistula Repair: Sensitive Quality Control using the Beta-Trace Protein Test

Abstract

Background After cerebrospinal fluid (CSF) fistula repair, the goal of watertight sealing may not always be achieved, causing postoperative CSF leakage. The aim of this study was to assess the novel application of the beta-trace protein (betaTP) test for postoperative screening and confirmation of dura repair success. Methods Prospectively, we investigated 32 consecutive patients who underwent dura repair. Postoperative nasal secretion and serum were analyzed for CSF marker betaTP, to detect or rule out postoperative CSF leakage. Results In 29 patients no CSF was detected, indicating 91% dura repair success after the first step. Three patients required additional surgery, verifying CSF leak. Additional betaTP testing was negative, revealing successful dura repair. Conclusion Dura repairs should be controlled for the presence or absence of postoperative CSF leakage. In our hands, the sensitive, fast, and inexpensive betaTP test has shown its value as an effective postoperative screening tool for dura repair success confirmation. Therefore, we consider it as novel “standard of care” and reserve invasive, more expensive or time-consuming methods as second choice.