The authors have no funding, financial relationships, or conflicts of interest to disclose.
Is the use of topical fluorescein helpful for management of CSF leakage?†
Article first published online: 27 MAR 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 6, pages 1215–1218, June 2012
How to Cite
Ozturk, K., Karabagli, H., Bulut, S., Egilmez, M. and Duran, M. (2012), Is the use of topical fluorescein helpful for management of CSF leakage?. The Laryngoscope, 122: 1215–1218. doi: 10.1002/lary.23277
- Issue published online: 1 JUN 2012
- Article first published online: 27 MAR 2012
- Manuscript Accepted: 10 FEB 2012
- Manuscript Revised: 21 JAN 2012
- Manuscript Received: 29 NOV 2011
- Cerebrospinal fluid leak;
- nasoseptal flap;
- Level of Evidence: 2c
We aimed to evaluate the effectiveness of topical intranasal fluorescence application together with high-resolution computed tomography and magnetic resonance imaging and/or magnetic resonance cisternography for the preoperative diagnosis of cerebrospinal fluid (CSF) leakage and for intraoperative localization of CSF fistulas. We also assessed postoperative recurrence.
Twenty-four cases underwent endonasal endoscopic repair for CSF leakage. Following intranasal topical application of fluorescein 10% to the middle turbinate-cribriform plate region and anterior wall of the sphenoid sinus, a color change of the fluorescein from yellow-brown to green was accepted as evidence of CSF leakage. A nasoseptal flap, collagen matrix, or fascia lata and septal cartilage graft were used for reconstruction of the CSF fistula.
The use of topical fluorescein application was helpful in diagnosing CSF rhinorrhea preoperatively and locating the CSF fistula intraoperatively. One case had both ethmoid roof and sphenoid sinus defects, and this case underwent a second operation for closure of the sphenoid defect. All CSF leakages were successfully repaired by endoscopic endonasal surgery using a nasoseptal flap.
Cases with traumatic CSF leakage pose a higher risk of meningitis than the cases with spontaneous CSF leakage. Topical application of fluorescein is highly specific and sensitive in identifying preoperative, intraoperative, and postoperative CSF leakage. It is a simple, quick, and sensitive technique. The surgeon should be vigilant for multiple defects.