Rapid Intrathecal Fluorescein Injection During Cerebrospinal Fluid Leak Repair Is Safe and Effective

Area of Science:

• Neurosurgery
• Otolaryngology
• Diagnostic Imaging

Background:

• Intrathecal fluorescein (IF) aids in locating cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery.
• Concerns regarding neurologic complications like seizures and paralysis have led to slow, diluted IF administration.
• The safety and accuracy of rapid IF injection for CSF leak identification remain unassessed.

Purpose of the Study:

• To evaluate the safety and diagnostic accuracy of rapid intrathecal fluorescein injection for identifying nasal CSF leaks.
• To determine if rapid IF administration is associated with neurologic complications.

Main Methods:

• A prospective study from 2015-2024 included patients undergoing endoscopic exploration for CSF rhinorrhea.
• A rapid injection of 0.1 mL of 10% fluorescein (10 mg) mixed with 3-5 mL of CSF was administered intrathecally via lumbar drain.
• The study assessed the sensitivity, specificity, and occurrence of neurologic complications associated with rapid IF injection.

Main Results:

• Eighty-two patients were included, with a mean age of 53.8 years; 84% were female.
• Rapid IF injection demonstrated 80% sensitivity and 100% specificity in identifying CSF leaks.
• No seizures, paralysis, or other neurologic complications were observed in relation to the rapid IF injection.

Conclusions:

• Rapid intrathecal fluorescein injection is a safe and effective method for localizing CSF leaks, comparable in efficacy to slower methods.
• The rapid administration of IF did not result in any IF-related complications in this study.
• Further research is recommended to corroborate these findings on rapid IF injection safety and efficacy.