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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Auris Nasus LarynxAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis.Rhinology. 2005 Dec 1; 43: 277
- Transnasal endoscopic repair of adult spontaneous cerebrospinal fluid rhinorrhea with assistance of computer-assisted navigation system: an analysis of 21 cases.Eur Arch Oto-Rhino-Laryngol. 2019 Oct 1; 276: 2835-2841
- Surgical outcomes of the endonasal endoscopic approach within a standardized management protocol for repair of spontaneous cerebrospinal fluid rhinorrhea.J Neurosurg. 2020 Feb 28; 1: 1-7
- Endoscopic repair of acquired encephaloceles, meningoceles, and meningo-encephaloceles: predictors of success.Skull Base. 2002; 12: 133-140
- Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis.Laryngoscope. 2000; 110: 1166-1172
- Endoscopic endonasal repair of spontaneous and traumatic cerebrospinal fluid rhinorrhea: a review and local experience.Neurosurg Clin N Am. 2015 Jul 1; 26: 333-348
- Management of Spontaneous CSF Rhinorrhea: An Institutional Experience.J Neurol Surg B Skull Base. Oct 2019; 80: 493-499
- Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States.Laryngoscope. 2004; 114: 266-272
- Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea.Laryngoscope. 1960; 70: 921-931
- Spectrum of complications in the use of intrathecal fluorescein.J Neurosurg. 1978; 48: 765-767
- Italian multicentre study on intrathecal fluorescein for craniosinusal fistulae.Acta Otorhinolaryngol Ital. 2008; 28: 159-163
- The use of low- dose intrathecal fluorescein in endoscopic repair of cerebrospinal fluid rhinorrhea.Arch Iran Med. 2013; 16: 264-266
- Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions.J Neurosurg. 2007; 106: 400-406https://doi.org/10.3171/jns.2007.106.3.400
- Endoscopic management of cerebrospinal fluid leaks.Am J Rhinol. 2002; 16: 17-23
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2 (Internet). Oxford Centre for Evidence-Based Medicine. https://www.cebm.net/index.aspx?o=5653.
- The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks.Am J Rhinol Allergy. 2021; 35: 879-884https://doi.org/10.1177/19458924211020564
- The Utility of Computed Tomography and Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leak.Am J Rhinol Allergy. May 2020; 34: 342-347
- Role of Blue-green-light Filter in Detecting a Spontaneous Cerebrospinal Fluid Rhinorrhea in an Unusual Site.Clin Rhinol An Int J. 2018; 11: 52-54
- Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years.Eur Arch Oto-Rhino-Laryngol. 2018 Oct 1; 275: 2487-2494
- Transnasal endoscopic management of anterior cerebrospinal fluid (CSF) leak: experience from a large case series.B-ENT. 2017 Jan 1; 13: 15-21
- Safe intrathecal fluorescein use for identification of cerebrospinal fluid leaks: Case-report and perioperative algorithm description.Rev Esp Anestesiol Reanim. 2017; 64: 533-536https://doi.org/10.1016/j.redar.2017.03.003
- The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly.Clin Neurol Neurosurg. 2015; 132: 21-25https://doi.org/10.1016/j.clineuro.2015.02.013
- Low-dose intrathecal fluorescein and etiology-based graft choice in endoscopic endonasal closure of CSF leaks.Clin Neurol Neurosurg. 2014 Jan 1; 116: 28-34
- Status epilepticus and intrathecal fluorescein: anesthesia providers beware.Anesth Analg. Jul 2008; 107: 229-231https://doi.org/10.1213/ane.0b013e318174dfbe
- Delayed absence seizure: A complication of intrathecal fluorescein injection: A case report and literature review.Auris Nasus Larynx. 2007 Dec 1; 34: 515-518
- A case of myelopathy after intrathecal injection of fluorescein.J Korean Neurosurg Soc. Dec 2007; 42 (Epub 2007 Dec 20): 492-494https://doi.org/10.3340/jkns.2007.42.6.492
- Endoscopic endonasal approach for cerebrospinal fluid fistulae.Minim Invasive Neurosurg. Apr 2006; 49: 88-92
- Endonasal endoscopic repair of cerebrospinal fluid rhinorrhea.Minim Invasive Neurosurg. Jun 2004; 47: 173-177
- Endoscopic repair of cerebrospinal fluid leaks after neurosurgical procedures.Am J Otolaryngol. 2003 Jul 1; 24: 213-216
- Endoscopic repair of spontaneous cerebrospinal fluid rhinorrhoea: a report of 3 cases.Med J Malaysia. Dec 2002; 57: 503-508
- Status epilepticus as a complication of intrathecal fluorescein.J Neurosurg. May 1972; 36: 659-660https://doi.org/10.3171/jns.1972.36.5.0659
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.