Is the use of topical fluorescein helpful for management of CSF leakage?

Öztürk, Kayhan; Karabağlı, Hakan; Bulut, Serap Pamak; Egilmez, Meryem; Duran, Mahmut Sami

doi:10.1002/lary.23277

Cited by 17 publications

(20 citation statements)

References 13 publications

(41 reference statements)

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“…Over the past 3 decades, multiple studies have demonstrated the safety and efficacy of endoscopic repair, with consensus that endoscopic repair should be considered the standard of care . Both intrathecal and topical use of fluorescein may augment intraoperative identification of a CSF fistula, though intrathecal usage has been associated with rare, but potentially serious complications . Nuances of surgical repair and postoperative intracranial pressure management are reviewed in the following sections.…”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Primary Csf Rhinorrheamentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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“…Currently, high-resolution CT scan, MRI scan, CT cisternography, MR cisternography, radionuclide cisternography, intrathecal fluorescein, and biochemical tests including b-2 transferrin or sugar and protein analysis are combined to detect CSF leakage. [15][16][17] In our study, we used a combination of the current techniques including b-2 transferrin analysis and MRI scan, high-resolution CT scan was also underwent in particular cases. We established correct diagnosis of the presence of CSF rhinorrhea preoperatively in 29 cases.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery

Zhang

Wang

Chen

et al. 2016

British Journal of Neurosurgery

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“…Several groups advocate for topical fluorescein in the localization of CSF rhinorrhea. These authors describe a color change in nasal pledgets from yellow‐brown to green as evidence of an active CSF leak . Although the success rates of topical fluorescein are reported as high as 100%, no studies have specifically evaluated the possibility of false‐positive results with blood products, mucus, or nasal secretions .…”

Section: Discussionmentioning

confidence: 99%

“…These authors describe a color change in nasal pledgets from yellow‐brown to green as evidence of an active CSF leak . Although the success rates of topical fluorescein are reported as high as 100%, no studies have specifically evaluated the possibility of false‐positive results with blood products, mucus, or nasal secretions . Furthermore, this test is only effective over applied areas; ie, if the patient has multiple skull‐base defects but only 1 is suspected it may be missed if only 1 area of the cranial base is investigated.…”

Section: Discussionmentioning

confidence: 99%

“…[48][49][50] Although the success rates of topical fluorescein are reported as high as 100%, no studies have specifically evaluated the possibility of false-positive results with blood products, mucus, or nasal secretions. 48 Furthermore, this test is only effective over applied areas; ie, if the patient has multiple skull-base defects but only 1 is suspected it may be missed if only 1 area of the cranial base is investigated. If validated, this test could represent a rapid, inexpensive, and sensitive test for the diagnosis and localization of CSF rhinorrhea.…”

Section: Discussionmentioning

confidence: 99%

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Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

Pool

Patel

Schilling

et al. 2019

Int Forum Allergy Rhinol

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Background The direct costs associated with different diagnostic algorithms to localize cerebrospinal fluid (CSF) rhinorrhea have not been described. Methods A decision‐tree analysis of imaging modalities used to localize CSF rhinorrhea was performed to compare associated direct costs. The primary outcome was cost, which was determined based on reimbursement data published by the Centers for Medicare and Medicaid Services in 2018. The model was parameterized after a literature review of published studies was performed from 1990 to 2018 to estimate the sensitivity CSF rhinorrhea localization of the following radiographic modalities: high‐resolution computed tomography (HRCT), magnetic resonance cisternography (MRC), and CT cisternography (CTC). In addition to base case analysis, 1‐way sensitivity analyses were also performed to evaluate the robustness of results to changes in model parameters. Results Among patients with a high suspicion for CSF rhinorrhea, use of HRCT followed by exploration in the operating room if preliminary HRCT was negative was found to be the optimal localization modality from a cost perspective ($172.25). The next least costly algorithm was HRCT followed by MRC ($294.10). Imaging algorithms beginning with CTC were the next least costly modality ($727.37). Sensitivity analyses generally supported HRCT to be the optimal initial radiographic strategy over a wide range of parameter values. Conclusion This work advocates HRCT as first‐line modality to localize CSF rhinorrhea from a cost perspective. Although algorithms beginning with MRC were on average $35 more expensive than those starting with CTC, associated risks of CTC were not modeled and may play a role in decision making.

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Is the use of topical fluorescein helpful for management of CSF leakage?

Cited by 17 publications

References 13 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery

Economic implications of localization strategies for cerebrospinal fluid rhinorrhea

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