Abstract
Background
Effective management of cerebrospinal fluid (CSF) leaks can reduce significant associated
morbidity. Intrathecal fluorescein (IF) may be a valuable intra-operative adjunct
to localise leak sites. Recent reports have demonstrated low doses of IF to be safe,
however, no internationally accepted dose of IF has been agreed.
Objective
To assess the efficacy and safety of IF used in the endoscopic management of anterior
skull base CSF fistulae.
Methods
A systematic review and descriptive analysis were performed of all published data
in accordance to PRISMA guidelines.
Results
There were 18 included articles giving a total of 335 procedures where IF was used.
Doses of IF ranged from 10mg - 150mg. IF positively identified the site of CSF fistula
in 88.7% of cases (n = 297). There was a total of 25 reported peri-operative complications
in all included studies (7.5%) with 5.1% (n = 17) potentially related to IF use. Of
these, the complication rate was 3.9% at low IF doses (<50mg) and 80.0% at higher
doses (50mg).
Conclusion
Our review demonstrates that IF is effective at localising CSF fistulae with most
significant complications being related to doses 50mg. We therefore propose that there is a potential for the licensing of IF in this
field. Doses <50mg have consistently been shown to be safe while still maintaining
effective localisation rates. Based on the most common doses used in this group, we
recommend utilisation of a dosing below 50mg, with the most frequent range being between
10-30mg.
Keywords
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Article Info
Publication History
Published online: April 04, 2022
Accepted:
March 13,
2022
Received:
January 9,
2022
Identification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
