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Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
Intrathecal fluorescein in endoscopic skull base surgery
Abtin Tabaee1, Dimitris G Placantonakis, Theodore H Schwartz
1Department of Otolaryngology--Head and Neck Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10002, USA.
Summary
Intraoperative fluorescein visualization during endoscopic skull base surgery can identify patients at low risk for cerebrospinal fluid (CSF) leaks. This finding aids in tailoring reconstruction efforts and improving patient outcomes.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Endoscopic skull base surgery necessitates meticulous reconstruction to prevent cerebrospinal fluid (CSF) leaks.
- The role of intraoperative CSF visualization techniques in predicting postoperative leaks remains unclear.
Purpose of the Study:
- To investigate the correlation between intraoperative fluorescein identification of CSF leaks and the incidence of postoperative CSF leakage.
- To determine if fluorescein can aid in stratifying reconstruction needs in endoscopic skull base surgery.
Main Methods:
- Retrospective review of 61 patients undergoing endoscopic skull base surgery with intrathecal fluorescein administration.
- Analysis of the relationship between intraoperative fluorescein-detected leaks and postoperative CSF leak occurrence.
Main Results:
- Postoperative CSF leak occurred in 19.4% (7/37) of patients with intraoperative fluorescein-identified leaks versus 0% (0/24) without (P = 0.02).
- The study included diverse pathologies such as pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%).
- All CSF leaks resolved successfully with lumbar drainage.
Conclusions:
- Absence of intraoperative fluorescein leakage is a strong indicator of low postoperative CSF leak risk.
- Intraoperative fluorescein can guide the extent of skull base reconstruction, potentially reducing morbidity.
