The cerebrospinal fluid (CSF) should have the following studies performed:
1. Cell count with cytocentrifuge slide examination for cytology of tumor cells
2. Glucose and protein content
3. CSF a-fetoprotein (AFP)
4. CSF human chorionic gonadotropin (hCG).
Polyamine assays in the CSF are of value in the evaluation of tumors that are in proximity to the circulating CSF (medulloblastoma, ependymoma, brain stem glioma). The assay is not useful in glioblastoma multiforme and not predictive in astrocytomas. AFP and hCG of the CSF may be elevated in CNS germ cell tumors.
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