Pool Christopher D, Patel Vijay A, Hwang Gloria, Barr Jeremy, Goyal Neerav
Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA.
World Neurosurg. 2021 Dec;156:e243-e248. doi: 10.1016/j.wneu.2021.09.042. Epub 2021 Sep 17.
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.
All otolaryngologists agreed a color difference could be seen with blood across all fluorescein concentrations. However, a perceptible color difference between the experimental samples that excluded blood was not appreciable. Objectively, the ΔE was <5 on average for all nonblood samples when mixed with 5% and 10% fluorescein in the Eppendorf experiment. The ΔE for the nonblood samples was >5 for the remaining tested. Similarly, the average ΔE for the nonblood samples in the pledget experiment was >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.
鼻内局部应用荧光素的颜色变化已被用于在内镜下鼻内手术中确认脑脊液（CSF）的存在。我们旨在验证鼻内局部应用荧光素用于脑脊液检测的有效性。
将血液、脑脊液、唾液和生理盐水与逐渐降低的荧光素浓度（从10%到0.1%）混合。将这些溶液在鼻棉片上和1.5毫升的艾本德管中进行高清拍照。通过国际照明委员会坐标客观测量颜色差异（ΔE）。四名不了解研究参数的耳鼻喉科医生也对样本进行了可察觉颜色差异的评估。人眼在国际照明委员会ΔE<5时无法检测到颜色差异。
所有耳鼻喉科医生都认为，在所有荧光素浓度下，血液都能看出颜色差异。然而，排除血液的实验样本之间可察觉的颜色差异并不明显。客观上，在艾本德实验中，所有非血液样本与5%和10%荧光素混合时，平均ΔE<5。其余测试中，非血液样本的ΔE>5。同样，在棉片实验中，所有荧光素浓度下非血液样本的平均ΔE>5。在艾本德实验中，所有荧光素浓度下血液的ΔE始终>50，在棉片实验中始终>20，这与两组中血液和对照样本之间主观上易于辨别相关。
仅颜色变化不足以确定脑脊液、唾液和盐水之间的差异。然而，使用这种方法可以很容易地识别出血液。除颜色变化外，还需要辅助特征来正确识别活动性脑脊液漏。
