Features of diagnosing cerebrospinal fluid leak in patients with severe traumatic brain injury

Background. The frequency of traumatic cerebrospinal fluid (CSF) leaks in fractures of the skull base is 33–40 %, intracranial purulent complications occur in 10–37 % of cases, and mortality rate is 30 % even with antibiotic therapy. The difficulty of diagnosing CSF leaks in patients with severe traumatic brain injury is caused by several factors: impossibility of gathering complaints from a patient with decreased alertness; difficulty to position a patient for instrumental diagnostics due to concomitant injuries; artificial ventilation; cerebrospinal fluid leak being masked by hemorrhagic secretions from the nose. Aim. To review the effectiveness of various diagnostic methods and algorithms for detection of cerebrospinal fluid leak and to access their feasibility in cases of potentially penetrating traumatic brain injury. Results. The study identified the main challenges of diagnosing cerebrospinal fluid leaks in intensive care patients, including difficulties in performing invasive neuroimaging methods, challenges in collecting nasal secretions for laboratory detection of CSF-specific markers, and the absence of fluorescein approved for intrathecal use in the Russian Federation. It was established that in severe cases, the most informative methods are brain CT and glucose oxidase test with radionuclide cisternography recommended in cases of uncertain results. Upon confirmation of cerebrospinal fluid leak, endoscopic nasal cavity revision and, if necessary, CSF fistula repair are advised. Conclusion. The findings emphasize the need for further research and refinement of diagnostic algorithms to improve the accuracy of traumatic CSF leak detection in patients with severe traumatic brain injuries.