Guidelines for Complications of Cancer Treatment Vol VIII Part B

difficult to appreciate. Characteristics of CSF (to bedistinguished from nasal/lacrimal secretionso CSF is clear and odourlesso Typical halo – sign when drop is placed on a cloth(30-90% specificity)o Biochemical analysis – high sugar (>30mg/dl isvirtually diagnostic, low proteins and highchloride)o beta2 transferrin corroborates the presence of CSFin the fluid. This test is very specific for thepresence of CSF (more than 90%). However it maynot be easily available.Anatomical localization of the site of leak is seldom aproblem in the postoperative patient. However a baselineCT or MRI is useful to:o Confirm the adequacy of the repair and look forany local collection.o To check for pneumocephalus and follow it insubsequent scan. ( if it increases, it denotesinadequate repair of skull base and lumbar drainin these cases would be counterproductive andwould require surgical intervention)o To rule out presence of raised ICP in form ofcerebral edema and hydrocephalus , which wouldlead to a high pressure CSF leak and requireprimary treatmentManagement of established leaksIn the setting of a postoperative leak, there have been norandomized trials to suggest the most desirable treatment. Agraded approach to management is advisable.248