Weiss Nora M, Andus Ingo, Schneider Armin, Langner Sönke, Schröder Stefanie, Schraven Sebastian P, Mlynski Robert
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Rostock;
Rostock University.
J Vis Exp. 2020 Feb 29(156). doi: 10.3791/60795.
In cases of cerebrospinal fluid (CSF) leaks, reliable detection of their origins is needed to seal the leak sufficiently and prevent complications, such as meningitis. A method is presented here using intrathecal administered fluorescein in a clinical case of bilateral congenital ear malformation. A fluorescent dye is administered intrathecally to achieve intraoperative visualization of CSF leaks. The dye is applied 20 min before surgery, and concentration of 5% is used. Per every 10 kg of body weight, 0.1 mL of the fluid is applied intrathecally. The fluorescein is visualized using a fully digital microscope. The origin of the fluid leak is identified in the stapes footplate. During primary surgery, it is sealed, and cochlea implantation is performed for hearing restoration. In this specific case, 6 weeks later, the implant was explanted due to acute meningitis, and the electrode array was left as a spacer. Postoperatively, in the aural smear, β-transferrin was detected. During a revision mastoidectomy, dislocated coverage of the leak was found. The stapes was removed and oval window sealed. Five days after revision surgery, no β-transferrin was detected in the aural smear. During the revision of cochlea implantation 6 months later, intact coverage of the oval niche was observed. Thus, intrathecal fluorescein application proves to be a reliable tool for the detection of CSF leaks. It facilitates the orientation in malformations and complicated or unknown surgical situs. In the literature, its use is described for CSF fistulas in endonasal surgery but is rarely described in skull base and mastoid surgeries. The method has been used successfully in several cases with CSF leaks, and the results confirm the feasibility of safely accessing the origin of the leak.
在脑脊液（CSF）漏的病例中，需要可靠地检测其来源，以便充分封闭漏口并预防并发症，如脑膜炎。本文介绍了一种在双侧先天性耳部畸形的临床病例中鞘内注射荧光素的方法。通过鞘内注射荧光染料以在术中可视化脑脊液漏。在手术前20分钟注射染料，使用的浓度为5%。每10千克体重鞘内注射0.1毫升该液体。使用全数字显微镜观察荧光素。确定漏液起源于镫骨足板。在初次手术中，封闭漏口，并进行人工耳蜗植入以恢复听力。在这个特定病例中，6周后，由于急性脑膜炎将植入物取出，电极阵列留作间隔物。术后，在耳拭子中检测到β-转铁蛋白。在翻修乳突切除术期间，发现漏口覆盖移位。取出镫骨并封闭卵圆窗。翻修手术后5天，耳拭子中未检测到β-转铁蛋白。6个月后在人工耳蜗植入翻修时，观察到卵圆窝覆盖完整。因此，鞘内应用荧光素被证明是检测脑脊液漏的可靠工具。它有助于在畸形以及复杂或不明手术部位中确定方位。在文献中，其在鼻内手术中用于脑脊液瘘的情况有描述，但在颅底和乳突手术中很少被描述。该方法已在几例脑脊液漏病例中成功应用，结果证实了安全找到漏口来源的可行性。
