Saafan Magdy E, Ragab Sameh M, Albirmawy Osama A
Department of Otolaryngology and Head and Neck Surgery, Tanta Faculty of Medicine and University Hospitals, Egypt.
Laryngoscope. 2006 Jul;116(7):1158-61. doi: 10.1097/01.mlg.0000217532.77298.a8.
The aim of this work was to focus on the development and validation of the use of topical fluorescein in the intraoperative localization of cerebrospinal fluid (CSF) fistulas, and to screen its use in preoperative diagnosis of CSF rhinorrhea as well as postoperative detection of a recurrence.
Twenty-five patients with CSF rhinorrhea were treated with an endoscopic endonasal technique. Topical intranasal 5% fluorescein was used for preoperative diagnosis and intraoperative localization of the site of the leak. A change in the color of the fluorescein from yellow to green fluorescence and sometimes streaming the fluorescein over the nasal mucosa and blood denoted the presence of CSF, and the site of the leak could be traced.
The cause of the leak was accidental trauma in 11 patients, spontaneous in 9 patients, and iatrogenic in 5 patients. The ethmoidal roof was the most common site of leak (52%) followed by the cribriform plate (40%) and then the sphenoid sinus (8%). We have achieved 100% success rate in sealing the CSF fistulas in our 25 patients with no recurrence detected during the follow-up period (mean, 19+/-10 months). The preoperative use of fluorescein-soaked cotton pledgets was 100% accurate in diagnosing CSF rhinorrhea when compared with B2 transferrin testing. The intraoperative use of topical intranasal fluorescein was also 100% accurate in locating the site of the CSF fistula when compared with the surgical findings. No major complications have been reported.
In the presence of a clinically diagnosed CSF leakage, topical fluorescein is a very easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas, and should be considered a viable noninvasive alternative to intrathecal fluorescein. We also recommend its use as a simple and quick outpatient clinic test for preoperative diagnosis of CSF rhinorrhea. It can be used postoperatively as well when there is a doubt of recurrence of the CSF leak.
本研究旨在聚焦于局部应用荧光素在脑脊液（CSF）瘘管术中定位的开发与验证，并探讨其在脑脊液鼻漏术前诊断及术后复发检测中的应用。
25例脑脊液鼻漏患者采用鼻内镜下鼻内技术治疗。局部鼻内应用5%荧光素用于术前诊断及术中漏口定位。荧光素颜色由黄色变为绿色荧光，有时荧光素在鼻黏膜和血液上流动，表明存在脑脊液，可追踪到漏口位置。
漏口原因：11例为意外创伤，9例为自发性，5例为医源性。筛窦顶是最常见的漏口部位（52%），其次是筛板（40%），然后是蝶窦（8%）。我们对25例患者封堵脑脊液瘘管的成功率达100%，随访期间（平均19±10个月）未发现复发。与B2转铁蛋白检测相比，术前使用荧光素浸泡棉片诊断脑脊液鼻漏的准确率为100%。与手术结果相比，术中局部鼻内应用荧光素定位脑脊液瘘管位置的准确率也为100%。未报告重大并发症。
在临床诊断为脑脊液漏的情况下，局部应用荧光素是术中定位脑脊液瘘管位置和范围的一种非常简便、敏感、安全且高度准确的工具，应被视为鞘内应用荧光素可行的非侵入性替代方法。我们还建议将其用作脑脊液鼻漏术前诊断的简单快速门诊检查。当怀疑脑脊液漏复发时，术后也可使用。
