Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea

Kirchner, Fernando R.; Proud, G. O.

doi:10.1288/00005537-196007000-00004

Cited by 94 publications

(42 citation statements)

References 5 publications

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“…In patients with a suspected cerebrospinal fluid (CSF) leakage, intrathecal injection of fluorescein has been used to identify the site of the leak for over 40 years 7,[10][11][12] . Accurate localization of the CSF leakage or the exclusion of the CSF leakage is essential for the management of these patients 4,5) .…”

Section: Introductionmentioning

confidence: 99%

A Case of Myelopathy after Intrathecal Injection of Fluorescein

Park

Kim

2007

J Korean Neurosurg Soc

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Section: Introductionmentioning

confidence: 99%

A Case of Myelopathy after Intrathecal Injection of Fluorescein

Park

Kim

2007

J Korean Neurosurg Soc

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“…1,15 Cisternography with iopamidol followed by thin-sectioned coronal-view CT scanning through the bone window is the best method for localization of the fistula, 7 although radionuclide cisternography remains a reliable method. 18 The exact localization of the site of leak is imperative, however, only if surgical repair is intended.…”

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confidence: 99%

Diagnosis and management of posttraumatic oculorrhea

Salame¹,

Segev²,

Fliss³

et al. 2000

FOC

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Posttraumatic cranio-orbital cerebrospinal fluid (CSF) fistula is very rare. Diagnosis of these fistulas may be difficult, and it is possible that this complication of craniofacial injury is underdiagnosed. Early recognition and adequate treatment is of paramount importance to prevent hazardous complications. The authors report the case of a 20-year-old woman in whom a CSF leak developed through the medial canthus area of her eye after she sustained a mild sports-related injury. Clinical examination and chemical analysis of the fluid led to the correct diagnosis, and the leak was stopped with conservative treatment. It is proposed that a CSF leak through the eye be termed “oculorrhea” as compared with otorrhea and rhinorrhea. The mechanism of the fistula in this patient is discussed, as is the pertinent radiologically demonstrated anatomy and the mechanism of injury. Management and controversies are also discussed.

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“…For this reason, some surgeons employ ITF to help visualize potentially small, unappreciated leaks that may require additional layers of closure of increasing complexity. 2,3,6,[9][10][11]13,[21][22][23] In this prospective study, we define the sensitivity, specificity, NPV, and PPV of using 25 mg ITF with white light excitation to detect CSF leaks, which we have already shown in prior studies to be safe. 1,8,17,22 In contrast to lower dosages of ITF, the 25-mg dose is much more specific and has a lower false-negative rate.…”

Section: Discussionmentioning

confidence: 99%

“…Using intrathecal fluorescein (ITF) injection to highlight CSF was described over 40 years ago. 10,11,15 The green fluorescence (peak emission wavelength 519 nm) can be detected with endoscopic white light illumination and is thought to easaBBreViatiONS ITF = intrathecal fluorescein; NPV = negative predictive value; PPV = positive predictive value. OBJectiVe The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks.…”

mentioning

confidence: 99%

“…Using intrathecal fluorescein (ITF) injection to highlight CSF was described over 40 years ago. 10,11,15 The green fluorescence (peak emission wavelength 519 nm) can be detected with endoscopic white light illumination and is thought to eas- Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study ily differentiate CSF from the surrounding liquids in the operative field, which may obscure the detection and localization of an intraoperative leak. Prior reports have described the utility and safety of fluorescein at variable doses, ranging from 10 to 250 mg.…”

mentioning

confidence: 99%

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Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study

Raza

Banu²,

Donaldson³

et al. 2016

JNS

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E ndoscopic endonasal approaches provide a minimal access corridor to the ventral skull base. Although anatomically appealing, the success and applicability of these approaches has hinged upon the surgeon's ability to successfully close the resulting defects in the skull base in order to prevent a postoperative CSF leak. The complications of an inadequate closure can also include meningitis and tension pneumocephalus. As such, a variety of closure methods have been developed, ranging from free tissue grafts and rigid buttresses to vascularized pedicled flaps and gasket seal closure; however, these techniques are not without morbidity and hence are used in a tailored fashion. The primary indication for utilizing a closure technique is the successful identification of intraoperative CSF leaks. 16 Hence, any method that increases the surgeon's ability to detect intraoperative CSF leaks would be potentially advantageous.Because CSF is translucent and the surgical cavity can contain small pools of blood and irrigation, it may be difficult to recognize small, low-flow CSF leaks. Using intrathecal fluorescein (ITF) injection to highlight CSF was described over 40 years ago. 10,11,15 The green fluorescence (peak emission wavelength 519 nm) can be detected with endoscopic white light illumination and is thought to easaBBreViatiONS ITF = intrathecal fluorescein; NPV = negative predictive value; PPV = positive predictive value. OBJectiVe The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks. Intrathecal fluorescein (ITF) has been used at varying doses to aid in the detection of intraoperative CSF leaks. However, the sensitivity and specificity of ITF at certain dosages is unknown. methOdS A prospective database of all endoscopic endonasal procedures was reviewed. All patients received 25 mg ITF diluted in 10 ml CSF and were pretreated with dexamethasone and Benadryl. Immediately after surgery, the operating surgeon prospectively noted if there was an intraoperative CSF leak and fluorescein was identified. The sensitivity, specificity, and positive and negative predictive power of ITF for detecting intraoperative CSF leak were calculated. Factors correlating with postoperative CSF leak were determined. reSultS Of 419 patients, 35.8% of patients did not show a CSF leak. Fluorescein-tinted CSF (true positive) was noted in 59.7% of patients and 0 false positives were encountered. CSF without fluorescein staining (false negative) was noted in 4.5% of patients. The sensitivity and specificity of ITF were 92.9% and 100%, respectively. The negative and positive predictive values were 88.8% and 100%, respectively. Postoperative CSF leaks only occurred in true positives at a rate of 2.8%. cONcluSiONS ITF is extremely specific and very sensitive for detecting intraoperative CSF leaks. Although false negatives can occur, these patients do not appear to be at risk for postoperative CSF leak. The use of ITF may help surgeons prevent postoperative CSF le...

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Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea

Cited by 94 publications

References 5 publications

A Case of Myelopathy after Intrathecal Injection of Fluorescein

A Case of Myelopathy after Intrathecal Injection of Fluorescein

Diagnosis and management of posttraumatic oculorrhea

Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study

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