Preoperative topical intranasal fluorescein in diagnosis of cerebrospinal fluid rhinorrhea

Jazi, Seyed Mostafa Hashemi; Amini, Zhale; Saboori, Masih; Raisi, Mostafa

doi:10.4103/atr.atr_87_18

Cited by 1 publication

(5 citation statements)

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“…There was no major complication reported for any patient (n=99) with either 5% or 10% fluorescein use. Jazi et al18 identified a minor complication rate of 25% (8/32 patients), defined by the authors as dizziness or occasional headache without meningeal signs. Other studies13,14 either reported no minor complications or did not include a record of minor complications in their study design 11,19–21…”

Section: Resultsmentioning

confidence: 99%

“…25 Given these challenges and that this approach is relatively contraindicated in patients with active meningitis or raised intracranial pressure, there is a need for alternative methods to localize CSF rhinorrhea. 26 Several prior studies suggest that topical intranasal fluorescein may serve as a viable alternative for localization of the intranasal CSF leaks 11,13,14,18–21. The present systematic review assesses technique, efficacy, and safety data available on this minimally invasive diagnostic test.…”

Section: Discussionmentioning

confidence: 99%

“…26 Several prior studies suggest that topical intranasal fluorescein may serve as a viable alternative for localization of the intranasal CSF leaks. 11,13,14,[18][19][20][21] The present systematic review assesses technique, efficacy, and safety data available on this minimally invasive diagnostic test.…”

Section: Discussionmentioning

confidence: 99%

“…11 Four studies reported the application of an anesthetic or hemostatic agent before fluorescein administration. 13,[18][19][20] The majority of the studies (n = 6, 85.7%) analyzed fluorescein color change immediately after application, whereas 1 study 13 left fluorescein pledgets in place for 5 minutes before examination. Taken together, we recommend assessing for color change immediately after fluorescein application.…”

Section: Discussionmentioning

confidence: 99%

“…One study administered intravenous antibiotics for 5 days and oral acetazolamide for 1 month after the repair procedure 11. Four studies reported the application of an anesthetic or hemostatic agent before fluorescein administration 13,18–20. The majority of the studies (n = 6, 85.7%) analyzed fluorescein color change immediately after application, whereas 1 study13 left fluorescein pledgets in place for 5 minutes before examination.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Evaluating the Efficacy of Topical Intranasal Fluorescein for Localizing CSF Rhinorrhea: A Systematic Review

Romeo

Fritz

et al. 2023

Journal of Craniofacial Surgery

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Although the COVID-19 pandemic has lost its strength, it persists. The importance of diagnosis in the control of this pandemic has been demonstrated. The naso/oro-pharyngeal swab test is still used more frequently for sample collection in COVID-19 due to its high sensitivity and specificity. 1 The complication rate for the nasopharyngeal swab collection technique is extremely low in the literature. Non-life-threatening complications, such as nonsevere epistaxis, are observed frequently, but broken swab sticks in the nasal cavity and stomach have also been reported on rare occasions. 2 It should be stated that another important complication for the medical profession is aerosol generation during the sampling process.In addition to the above-mentioned low-risk complications, serious life-threatening complications may be observed in the literature, including the aspiration of a broken swab stick during the collection of samples from the tracheotomy tube. Cases of CSF rhinorrhea (similar to the present case) after the sampling process have also been reported in the literature. [3][4][5] The authors stated that encephalocele was reported in the first and second cases. 3,4 In the third case, meningitis due to CSF leakage after swab testing was seen and CSF rhinorrhea was stopped after empirical antibiotics treatment. 5 In the present case, CSF rhinorrhea that appeared immediately after sampling was observed, and it is noteworthy that the patient's radiological images did not have any findings compatible with any encephalocele or similar.Sampling with a nasopharyngeal swab for COVID-19 is the most important step for obtaining accurate results in the diagnosis of COVID-19. The most important condition for sampling from the nasopharynx by the transnasal route is to know nasal anatomy well. The situation that should be kept in mind is the fact that the swab stick, after passing through the nostril and advancing parallel and close to the nasal floor, safely reaches the nasopharynx. One of the appropriate methods for assessing whether the nasopharynx has been reached is to evaluate the distance. The distance from the nostril to the external ear canal entrance should be kept in mind as an easy method that roughly shows how far the distance from the nostril to the nasopharynx might be. In cases where the distance cannot be covered, intranasal pathologies should be considered, and it might be safer to try sampling from the other nasal cavity. CONCLUSIONWhen the literature is examined, the rate of life-threatening complications is quite low. Sampling should be performed by an experienced health care worker to reduce the rate of serious complications, anatomical variations should be considered, and sampling should be done at an angle appropriate to the anatomy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%