The efficacy and safety of intrathecal fluorescein in endoscopic cerebrospinal fluid leak repair –a systematic review

Effective management of cerebrospinal fluid (CSF) leaks can reduce significant associated morbidity. Intrathecal fluorescein (IF) may be a valuable intra-operative adjunct to localise leak sites. Recent reports have demonstrated low doses of IF to be safe, however, no internationally accepted dose o...

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Bibliographic Details
Published in:Auris, nasus, larynx nasus, larynx, 2022-12, Vol.49 (6), p.912-920
Main Authors: Jolly, Karan, Gupta, Keshav Kumar, Muzaffar, Jameel, Ahmed, Shahzada K
Format: Article
Language:English
Subjects:
Cerebrospinal fluid
CSF
CSF fistula
CSF leak
Endoscopic surgery
Fluorescein
Intrathecal fluorescein
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Summary:Effective management of cerebrospinal fluid (CSF) leaks can reduce significant associated morbidity. Intrathecal fluorescein (IF) may be a valuable intra-operative adjunct to localise leak sites. Recent reports have demonstrated low doses of IF to be safe, however, no internationally accepted dose of IF has been agreed. To assess the efficacy and safety of IF used in the endoscopic management of anterior skull base CSF fistulae. A systematic review and descriptive analysis were performed of all published data in accordance to PRISMA guidelines. There were 18 included articles giving a total of 335 procedures where IF was used. Doses of IF ranged from 10mg - 150mg. IF positively identified the site of CSF fistula in 88.7% of cases (n = 297). There was a total of 25 reported peri-operative complications in all included studies (7.5%) with 5.1% (n = 17) potentially related to IF use. Of these, the complication rate was 3.9% at low IF doses (
ISSN:0385-8146
1879-1476
DOI:10.1016/j.anl.2022.03.014