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Updated: May 21, 2025
Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
Rapid Intrathecal Fluorescein Injection During Cerebrospinal Fluid Leak Repair Is Safe and Effective
Hussein Mackie1, Jacob G Eide2, Abdul Yassin-Kassab1
1Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
Objective:
Intrathecal fluorescein (IF) is effective for localizing nasal cerebrospinal fluid (CSF) leaks along the skull base during endoscopic exploration, with largest studies reporting sensitivities ranging from 66%-93%. Due to reports of intraoperative and postoperative neurologic complications such as seizures and paralysis, surgeons often dilute the fluorescein and inject it intrathecally slowly over a variable amount of time. However, no study has assessed whether rapid IF administration causes the aforementioned risks or whether it affects its accuracy in identifying CSF leaks intraoperatively.
Methods:
A prospective study was conducted from 2015 to 2024, where all patients undergoing endoscopic exploration and/or repair of CSF rhinorrhea had 0.1 mL of 10% fluorescein (10 mg) mixed with 3-5 mL of patients' CSF injected rapidly via the lumbar drain over a few seconds.
Results:
Of the 82 included patients, the mean age was 53.8 ± 15.2 years, and 84% were female. Sixty-nine patients underwent successful endoscopic CSF leak repairs, and 13 had negative endoscopic explorations. Rapid IF injection was 80% sensitive (20% false negative rate) and 100% specific for identifying CSF leaks, and it caused no seizures, paralysis, or other neurologic complications.
Conclusion:
Compared to prior reports of slow low-dose IF injection for CSF leak localization, rapid IF injection yielded similar efficacy (80% sensitivity) with no IF-related complications. Rapid IF injection was safe and effective but should be corroborated by future studies.
