Albaharna Hussain, Alshareef Mohammad, Alromaih Saud, Aloulah Mohammad, Alsaleh Saad, Alroqi Ahmad
Department of Otolaryngology-Head and Neck surgery, Qatif Central Hospital, Qatif, Eastern province, Saudi Arabia.
Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
Turk Arch Otorhinolaryngol. 2021 Sep;59(3):223-229. doi: 10.4274/tao.2021.2021-3-12. Epub 2021 Oct 15.
This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak.
A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications.
After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series.
Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.
本研究评估关于使用局部鼻内荧光素（TINF）诊断和定位鼻脑脊液（CSF）漏的现有证据。
通过PubMed、Cochrane数据库、Scopus和Ovid进行文献检索，以确定能深入了解使用TINF术前诊断CSF漏或术中定位漏口的文章。数据库中的文章由两位作者根据选择标准进行筛选和过滤。创建了一个电子表格来收集数据，包括人口统计学特征、TINF诊断和定位CSF漏的敏感性和特异性、应用TINF的方案以及并发症。
在排除重复文章和不符合我们选择标准的文章后，我们在最终分析中纳入了五篇报告。94名参与者的平均年龄为39.5岁，男女分布均衡。TINF术前诊断CSF漏的敏感性为100%，术中定位漏口的敏感性为97%。所有报告均未提及与TINF相关的并发症。基于五个病例系列，本综述显示为C级推荐。
根据目前的证据，不推荐将TINF用于标准临床实践。然而，在没有其他金标准工具的情况下可以考虑使用，因为它可行且易于使用。应进行标准化对照试验以获得更多无偏倚的证据。
