neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2025-27-2-161-170neurosurgery-1695Research ArticleЛЕКЦИЯLECTUREОсобенности диагностики базальной ликвореи у пациентов с тяжелой черепно-мозговой травмойFeatures of diagnosing cerebrospinal fluid leak in patients with severe traumatic brain injuryhttps://orcid.org/0000-0001-9161-6035РощинаД. В.RoshchinaD. V.

Дарья Викторовна Рощина

129090 Москва, Большая Сухаревская пл., 3

Darya Viktorovna Roshchina 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

koneva.darya92@gmail.comhttps://orcid.org/0000-0001-8651-9986ГодковИ. М.GodkovI. M.

129090 Москва, Большая Сухаревская пл., 3

117997 Москва, ул. Островитянова, 1

108814 Москва, ул. Сосенский Стан, 8, стр. 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovitianov St., Moscow 117997

Bld. 3, 8 Sosenskii Stan St., Moscow 108814

https://orcid.org/0000-0003-3515-8329ГриньА. А.GrinA. A.

129090 Москва, Большая Сухаревская пл., 3

117997 Москва, ул. Островитянова, 1

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovitianov St., Moscow 117997

https://orcid.org/0000-0002-0149-0676КрюковА. И.KryukovA. I.

117152 Москва, Загородное ш., 18а, стр. 2

Bld. 2, 18а Zagorodnoe Hwy., Moscow 117152

https://orcid.org/0000-0003-2473-3113ГаровЕ. В.GarovE. V.

117152 Москва, Загородное ш., 18а, стр. 2

Bld. 2, 18а Zagorodnoe Hwy., Moscow 117152

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России; ГБУЗ «Московский многопрофильный клинический центр «Коммунарка» Департамента здравоохранения г. Москвы»РоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; The Russian National Research Medical University named after N. I. Pirogov; Moscow Multiprofile Clinical Center “Kommunarka”, Moscow Healthcare DepartmentRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава РоссииРоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; The Russian National Research Medical University named after N. I. PirogovRussian FederationГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л. И. Свержевского» Департамента здравоохранения г. МосквыРоссияТhe Sverzhevskiy Otorhinolaryngology Healthcare Research InstituteRussian Federation202518082025272161170Copyright © Рощина Д.В., Годков И.М., Гринь А.А., Крюков А.И., Гаров Е.В., 20252025Рощина Д.В., Годков И.М., Гринь А.А., Крюков А.И., Гаров Е.В.Roshchina D.V., Godkov I.M., Grin A.A., Kryukov A.I., Garov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1695Введение

Введение. Частота посттравматической базальной ликвореи (ПБЛ) при переломах основания черепа составляет 33–40 %, развитие внутричерепных гнойных осложнений при этом состоянии наблюдается в 10–37 % случаев, а уровень летальности может достигать 30 % даже при проведении антибактериальной терапии. Сложность диагностики базальной ликвореи (БЛ) у пациентов с тяжелой черепно-мозговой травмой (ЧМТ) обусловливает ряд причин – невозможность сбора жалоб со стороны пациента с угнетенным уровнем бодрствования; затрудненность укладки пациентов для проведения инструментальной диагностики за счет сочетанных повреждений; нахождение на искусственной вентиляции легких; маскировка истечения ликвора из-за геморрагического характера отделяемого из полости носа.

Цель работы – обзор эффективности различных диагностических методов и алгоритмов для выявления БЛ, а также их применимости в случаях ЧМТ с подозрением на проникающий характер.

Результаты

Результаты. Выявлены основные сложности диагностики БЛ у реанимационных пациентов, связанные с рядом проблем при выполнении инвазивных методов нейровизуализации и сбора ликвореи для лабораторной диагностики по специфическим маркерам цереброспинальной жидкости, а также с отсутствием флуоресцеина, разрешенного для интратекального применения на территории Российской Федерации. Установлено, что в случаях тяжелого состояния пациента наиболее информативными методами диагностики служат компьютерная томография головного мозга и глюкозооксидазный тест, а в случае сомнительных результатов – радионуклидная цистернография. После подтверждения БЛ рекомендуется эндоскопическая ревизия полости носа и, при необходимости, пластика ликворной фистулы.

Заключение

Заключение. Представленные данные подчеркивают необходимость дальнейших исследований и уточнения диагностических алгоритмов с целью повысить точность выявления ПБЛ у пациентов с тяжелой ЧМТ.

Background

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

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

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

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.

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The authors declare that there are no conflicts of interest present.