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Is topical fluorescein that effective in endoscopic CSF leak closure?

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Several diagnostic modalities are used to detect CSF leaks. Intraoperative use of intrathecal fluorescein can help to detect and localize a CSF leak simultaneously. However, it is not FDA approved, the application is invasive and has serious complications. Topical fluorescein is reported to be a safe and sensitive alternative to ITF. In this study, we aimed to evaluate the effectiveness of topical fluorescein in CSF leak closure.

Methods

This retrospective study includes 27 consecutive patients (19 women, 8 men) who underwent endoscopic endonasal CSF leak closure using topical fluorescein, between 2011 and 2017.

Results

In two patients, radiologic studies false positively locate the defect. β2 transferrin and topical fluorescein tests were positive in these patients. Both cases needed a second operation.

Conclusion

If radiologic studies fail to locate the defect properly, topical fluorescein only confirms the CSF leak, but the defect cannot be located anatomically intraoperatively.

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References

  1. Kljajić V, Vuleković P, Vlaški L, Savović S, Dragičević D, Papić V (2017) Endoscopic repair of cerebrospinal fluid rhinorrhea. Braz J Otorhinolaryngol 83(4):388–393

    Article  Google Scholar 

  2. LaFata V, McLean N, Wise SK, DelGaudio JM, Hudgins PA (2008) CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings. AJNR Am J Neuroradiol. 29:536–541

    Article  CAS  Google Scholar 

  3. Lloyd KM, DelGaudio JM, Hudgins PA (2008) Imaging of skull base cerebrospinal fluid leaks in adults. Radiology. 248:725–736

    Article  Google Scholar 

  4. Lam A, Holbrook E (2013) Skullbase anatomy and CSF rhinorrhea. Adv Otorhinolaryngol 74:1–11

    PubMed  Google Scholar 

  5. Banua MA, Kima JH, Shina BJ, Woodworth GF, Anand VK, Schwartz TH (2014) Low-dose intrathecal fluorescein and etiology-based graft choice in the endoscopic endonasal closure of CSF leaks. Clin Neurol Neurosurg 116:28–34

    Article  Google Scholar 

  6. Jones ME, Reino T, Gnoy A, Guillory S, Wackym P, Lawson W (2000) Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye. Am J Rhinol. 14:93–96

    Article  CAS  Google Scholar 

  7. Liu HS, Chen YT, Wang D et al (2009) The use of topical intranasal fluorescein in the endoscopic endonasal repair of cerebrospinal fluid rhinorrhea. Surg Neurol 72:341–346

    Article  Google Scholar 

  8. Ozturk K, Karabagli H, Bulut S, Egilmez M, Duran M (2012) Is the use of topical fluorescein helpful for management of CSF leakage? Laryngoscope 122:1215–1218

    Article  CAS  Google Scholar 

  9. Felisati G, Bianchi A, Lozza P, Portaleone S (2008) Italian multicentre study on intrathecal fluorescein for craniosinusal fistulae. Acta Otorhinolaryngol Ital 28:159–63

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Oakley GM, Alt JA, Schlosser RJ et al (2016) Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol 6(1):8–16

    Article  Google Scholar 

  11. Moseley JI, Carton CA, Stern WE (1978) The spectrum of complications in the use of intrathecal fluorescein. J Neurosurg. 48(5):765–7

    Article  CAS  Google Scholar 

  12. Seth R, Rajasekaran K, Benninger MS et al (2010) The utility of intrathecal fluorescein in cerebrospinal fluid leak repair. Otolaryngol Head Neck Surg 143(5):626–32

    Article  Google Scholar 

  13. Gonen L, Monteiro E, Klinomoros G et al (2015) Endoscopic endonasal repair of spontaneous and traumatic cerebrospinal fluid rhinorrhea a review and local experience. Neurosurg Clin N Am. 26:333–348

    Article  Google Scholar 

  14. Saafan ME, Ragab SM, Albirmawy OA (2006) Topical intranasal fluorescein: the missing partner in algorithms of cerebrospinal fluid fistula detection. Laryngoscope 116(7):1158–61

    Article  Google Scholar 

  15. Xie T, Sun W, Zhang X et al (2016) The value of 3D-FIESTA MRI in detecting non-iatrogenic cerebrospinal fluid rhinorrhoea: correlations with endoscopic endonasal surgery. Acta Neurochir (Wien). 158(12):2333–2339

    Article  Google Scholar 

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Acknowledgements

A part of this study was presented as an oral abstract in the 4th Congress of European ORL-HNS.

Funding

This study has not received any specifc funding.

Author information

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, İzmir Atatürk Research and Education Hospital, Basın sitesi Mh. Hasan Tahsin Cd., No: 143, Karabaglar, İzmir, Turkey

    Erdem Eren, Akif İşlek, Seçil Arslanoğlu & Kazım Önal

  2. Department of Neurosurgery, İzmir Atatürk Research and Education Hospital, Konak, Turkey

    Gönül Güvenç & Nurullah Yüceer

Authors
  1. Erdem Eren
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  2. Gönül Güvenç
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  3. Akif İşlek
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  4. Seçil Arslanoğlu
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  5. Kazım Önal
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  6. Nurullah Yüceer
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Corresponding author

Correspondence to Erdem Eren.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Eren, E., Güvenç, G., İşlek, A. et al. Is topical fluorescein that effective in endoscopic CSF leak closure?. Eur Arch Otorhinolaryngol 277, 1073–1077 (2020). https://doi.org/10.1007/s00405-019-05766-1

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  • DOI: https://doi.org/10.1007/s00405-019-05766-1

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