Color Change of Intranasal Fluorescein Cannot Detect Cerebrospinal Fluid Leaks

The color change of topical intranasal fluorescein has been used to confirm the presence of cerebrospinal fluid (CSF) during endoscopic endonasal surgery. We aimed to validate the use of topical intranasal fluorescein for CSF detection. Blood, CSF, saliva, and normal saline were combined with decrea...

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Bibliographic Details
Published in:World neurosurgery 2021-12, Vol.156, p.e243-e248
Main Authors: Pool, Christopher D., Patel, Vijay A., Hwang, Gloria, Barr, Jeremy, Goyal, Neerav
Format: Article
Language:English
Subjects:
Administration, Intranasal
Anterior skull base surgery
Cerebrospinal Fluid Leak - diagnosis
Cerebrospinal Fluid Rhinorrhea - surgery
Color
Contrast Media - administration & dosage
CSF leak
CSF leak detection
CSF rhinorrhea
Endoscopy
Fluorescein - administration & dosage
Humans
Nasal Cavity - surgery
Observer Variation
Otolaryngologists
Saliva - chemistry
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Summary:The color change of topical intranasal fluorescein has been used to confirm the presence of cerebrospinal fluid (CSF) during endoscopic endonasal surgery. We aimed to validate the use of topical intranasal fluorescein for CSF detection. Blood, CSF, saliva, and normal saline were combined with decreasing fluorescein concentrations (from 10% to 0.1%). The solutions were photographed in high definition on nasal pledgets and in 1.5-mL Eppendorf tubes. The color difference (ΔE) was objectively measured via the International Commission on Illumination coordinates. Four otolaryngologists who were unaware of the study parameters also evaluated the samples for perceptible color differences. The human eye cannot detect color differences at an International Commission on Illumination ΔE of 5 across all fluorescein concentrations. The blood ΔE was consistently >50 throughout all fluorescein concentrations in the Eppendorf experiment and >20 throughout the pledget experiment, correlating with the subjective ease of discernment between blood and the control sample in both groups. Color change alone is not sufficient to determine a difference between CSF, saliva, and saline. Blood, however, is readily identified using this method. Adjunct characteristics, in addition to the color change, are necessary to properly identify an active CSF leak.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2021.09.042