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Updated: Mar 17, 2026
Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
Use of Intrathecal Fluorescein in Recurrent Meningitis after Cochlear Implantation
Swati Tandon1, Satinder Singh1, Shalabh Sharma2
1Department of Otorhinolaryngology, Sir Ganga Ram Hospital, Delhi, India.
Introduction:
Congenital anomalies of the cochlea and labyrinth can be associated with meningitis and varying degrees of hearing loss or deafness. Despite antibiotics, meningitis remains a life threatening complication.
Case Report:
We report a case of recurrent meningitis following episodes of otitis media in a cochlear implantee child with bilateral vestibulocochlear malformation, due to fistula in the stapes footplate. Intrathecal fluorescin was used to identify the leak site.
Conclusion:
Recurrent meningitis can indicate for possible immunological or anatomical abnormalities as well for chronic parameningeal infections. Intraoperative use of intrathecal fluorescin is an ideal investigative tool to demonstrate cerebrospinal fluid (CSF) leak site in patients in whom other investigations fail to do so.
Insights
Recurrent meningitis in a cochlear implantee with inner ear malformations was linked to a cerebrospinal fluid leak. Intrathecal fluorescein successfully identified the fistula, aiding diagnosis.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Congenital cochlear and labyrinth anomalies can predispose individuals to meningitis and hearing loss.
- Meningitis, despite antibiotic treatment, poses a significant life-threatening risk.
Observation:
- A cochlear implant recipient with bilateral vestibulocochlear malformation experienced recurrent meningitis after otitis media episodes.
- A fistula in the stapes footplate was identified as the cause of recurrent meningitis.
Findings:
- Intrathecal fluorescein injection effectively localized the cerebrospinal fluid (CSF) leak.
- The study highlights a rare case of recurrent meningitis due to a stapes footplate fistula in a pediatric cochlear implantee.
Implications:
- Recurrent meningitis warrants investigation for underlying anatomical abnormalities or infections.
- Intraoperative intrathecal fluorescein is a valuable tool for diagnosing CSF leaks when other methods fail.
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