A Makeshift Blue Light Filter for Endoscopic Identification of Traumatic Cerebrospinal Fluid Leak Using Fluorescein

Abstract


 
 
 
 ABSTRACTObjective: To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient.
 
 
 
 
 Methods:Study Design:Surgical Instrumentation
 Setting:Tertiary Government Training Hospital
 Patient:One
 
 
 
 
 Results: Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted.
 
 
 
 
 Conclusion: Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

High-Resolution Computed Tomography as an Initial Diagnostic and Localization Tool in Patients with Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis

“…In other words, these methods have limitations as initial diagnostic tools. Magnetic resonance cisternography has the advantage of requiring no intrathecal contrast agent injection, and T2-weighted images with high signal intensity can be helpful for localizing CSF leakage points [ 24 ]. However, the lack of information on bony structures and the high cost (more than five times higher than HRCT) reduce the attractiveness of magnetic resonance cisternography for initial leakage point localization [ 6 ].…”

“…However, the lack of information on bony structures and the high cost (more than five times higher than HRCT) reduce the attractiveness of magnetic resonance cisternography for initial leakage point localization [ 6 ]. Recently, in addition to imaging tools, studies have been reported that can effectively check the CSF leak site using an endoscope equipped with a blue light filter after intrathecal fluorescein administration, increasing the number of options for diagnostic testing [ 24 ].…”