Hypodense Sodium Fluorescein for Diagnosis and Skull Base Cerebrospinal Fluid Leak Repair

Galicia, Juan Eugenio Salas; Clinic, Santé Medical

doi:10.24966/ohns-010x/100023

Cited by 1 publication

(10 citation statements)

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“…Injection times were variable between studies, ranging from 1 to 30 minutes with an average administration time of 11.9 ± 11.2 minutes. Among these studies, IF was injected over a period of 1 minute (1 study 1 ), 5 minutes (1 study 17 ), between 10 and 15 minutes (3 studies 19,27,30 ), and over 30 minutes (1 study 10 ). Two studies 8,24 reported injecting IF over a period of "several minutes" and 7 studies 11,16,18,21,26,30,31 reported injecting "slowly" over an undisclosed period of time.…”

Section: Administration Techniquesmentioning

confidence: 99%

“…Among these studies, IF was injected over a period of 1 minute (1 study 1 ), 5 minutes (1 study 17 ), between 10 and 15 minutes (3 studies 19,27,30 ), and over 30 minutes (1 study 10 ). Two studies 8,24 reported injecting IF over a period of "several minutes" and 7 studies 11,16,18,21,26,30,31 reported injecting "slowly" over an undisclosed period of time. Five studies 8,16,24,26,30 documented premedication of all patients with diphenhydramine and dexamethasone to mitigate chemical irritation of the meninges.…”

Section: Administration Techniquesmentioning

confidence: 99%

“…Two studies 8,24 reported injecting IF over a period of "several minutes" and 7 studies 11,16,18,21,26,30,31 reported injecting "slowly" over an undisclosed period of time. Five studies 8,16,24,26,30 documented premedication of all patients with diphenhydramine and dexamethasone to mitigate chemical irritation of the meninges.…”

Section: Administration Techniquesmentioning

confidence: 99%

“…Fluorescein was mixed with CSF in 16 studies, 1,[8][9][10][11]16,[18][19][20]23,24,26,27,[29][30][31] normal saline in 2 studies, 26,32 distilled water in 8 studies, 9,12,17,21,22,25,32,33 and double distilled water (DDW) in 1 study. 30 Waiting times before using the endoscope to identify fluorescein-stained CSF ranged from 10 minutes to several hours. 31 Average waiting time data could not be reliably aggregated as reported values were often nonspecific or reported as ranges.…”

Section: Administration Techniquesmentioning

confidence: 99%

“…Thirteen studies 1,8,[10][11][12]16,17,[19][20][21]25,30,33 (n = 1688) reported data on IF sensitivity, specificity, TPR, TNR, false negative rate (FNR), NPV, and/or PPV (Supplemental Table 3, Supplemental Digital Content 4, http://links.lww.com/SCS/E261). There were no reported false positives, as CSF is the obligatory carrier of fluorescein around the skull base when administered intrathecally.…”

Section: Efficacy and Safetymentioning

confidence: 99%

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Systematic Review: Evaluating the Efficacy of Intrathecal Fluorescein for Localizing Cerebrospinal Fluid Rhinorrhea

Romeo

et al. 2022

Journal of Craniofacial Surgery

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Objectives: A defect in the skull base can result in leakage of cerebrospinal fluid (CSF) out of the subarachnoid space into the sinonasal cavities, termed CSF rhinorrhea. Patients presenting with CSF rhinorrhea often require surgical repair, typically performed endoscopically. Successful surgical intervention is highly reliant on accurate identification of the leak site. Identification can be enhanced by the administration of intrathecal fluorescein (IF) via a lumbar drain before surgery. The objective of this systematic review is to better characterize the benefits and limitations of IF administration. Methods: A systematic search was conducted for literature documenting the use of IF for CSF leak localization. The results of this search were subjected to initial review, followed by fulltext evaluation of selected texts, and final inclusion based on predetermined selection criteria. Primary outcomes were specificity and sensitivity of IF administration in identifying CSF leak sites. Secondary outcomes included administration technique and safety data. Results: A total of 25 studies representing 3801 instances of IF administration met inclusion criteria. When injected slowly for up to 30 minutes at doses of <50 mg, IF administration results in minimal complications. A total of 25 mg doses (92.36%) of IF appear more sensitive than 10 mg (71.88%) doses of IF while maintaining a similar safety profile. Mixing fluorescein with double distilled water instead of CSF or saline may decrease waiting times before fluorescein can be identified and increase its safety profile.Conclusions: Intrathecal fluorescein may play an important role in the identification of CSF leak site during endoscopic repair.

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