Chemical and cytological analysis of cerebral spinal fluid after intrathecal injection of hypodense fluorescein

Abstract

Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48h and an increase of neutrophils at 24h, with a subsequent decrease at 48h with no correlation with symptomatology.

Systematic Review: Evaluating the Efficacy of Intrathecal Fluorescein for Localizing Cerebrospinal Fluid Rhinorrhea

“…Ten included prospective data collection and 8 noted prospective calculations of the study size. Only 1 study12 had a baseline equivalence of groups. Given the nonrandomized nature of the studies, no study had adequate control groups or contemporary groups.…”

“…Of the 14 studies 1,10,12,[16][17][18][19][20][21][22][23][24][25][26] (n = 623) that reported skull base defect etiology data, 44% (n = 274) were the result of trauma, and the remaining 56% (n = 249) were nontraumatic. Only 1 study 27 reported comorbidities of all patients who had IF injections in their cohort; 82% of these patients were obese.…”

“…Among these studies, IF was injected over a period of 1 minute (1 study 1 ), 5 minutes (1 study 17 ), between 10 and 15 minutes (3 studies 19,27,30 ), and over 30 minutes (1 study 10 ). Two studies 8,24 reported injecting IF over a period of "several minutes" and 7 studies 11,16,18,21,26,30,31 reported injecting "slowly" over an undisclosed period of time. Five studies 8,16,24,26,30 documented premedication of all patients with diphenhydramine and dexamethasone to mitigate chemical irritation of the meninges.…”

The use of intrathecal fluorescein in cerebrospinal fluid leak repair: management from an anesthesiologist's point‐of‐view

“…Glucuronidation is active 2 min after intravenous injection and after 60 min over 80% is glucuronated. Guimarães et al 17 evaluated CSF through chemical and cytological analysis after intrathecal injection of a hypodense fluorescein solution. While most fluorescein is eliminated after 24 h, it can be traced in urine up to a week after its infusion.…”

“…16 Acute instillation in the CSF of high doses led to the occurrence of microscopic changes in the central nervous system consistent with the introduction of an irritant material. Guimarães et al 17 evaluated CSF through chemical and cytological analysis after intrathecal injection of a hypodense fluorescein solution. The authors noticed an increase in cell number between 24 and 48 h as well as an increase in neutrophils at 24 h, with subsequent decrease at 48 h. Protein levels increased at 24 and 48 h, and there were no changes in glucose levels.…”