Diagnostic Tools and Imaging for Skull Base Cerebrospinal Fluid Leak.

The diagnosis of skull base cerebrospinal fluid (CSF) leaks remains challenging and requires a multidisciplinary approach. Clinical evaluation and targeted endoscopic examination are essential, but laboratory confirmation with beta-2 transferrin or beta-trace protein provides the most reliable noninvasive evidence. Imaging modalities such as high-resolution computed tomography (CT), magnetic resonance cisternography, CT cisternography, and radionuclide studies complement detection and localization, guiding surgical planning. Intraoperative fluorescein enhances defect identification. Each diagnostic tool offers unique strengths and limitations, and their judicious combination enables accurate detection, localization, and management of CSF leaks.