Perelman School of Medicine, University of Pennsylvania.
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.
J Craniofac Surg. 2022;33(8):2581-2585. doi: 10.1097/SCS.0000000000008849. Epub 2022 Sep 22.
A defect in the skull base can result in leakage of cerebrospinal fluid (CSF) out of the subarachnoid space into the sinonasal cavities, termed CSF rhinorrhea. Patients presenting with CSF rhinorrhea often require surgical repair, typically performed endoscopically. Successful surgical intervention is highly reliant on accurate identification of the leak site. Identification can be enhanced by the administration of intrathecal fluorescein (IF) via a lumbar drain before surgery. The objective of this systematic review is to better characterize the benefits and limitations of IF administration.
A systematic search was conducted for literature documenting the use of IF for CSF leak localization. The results of this search were subjected to initial review, followed by full-text evaluation of selected texts, and final inclusion based on predetermined selection criteria. Primary outcomes were specificity and sensitivity of IF administration in identifying CSF leak sites. Secondary outcomes included administration technique and safety data.
A total of 25 studies representing 3801 instances of IF administration met inclusion criteria. When injected slowly for up to 30 minutes at doses of <50 mg, IF administration results in minimal complications. A total of 25 mg doses (92.36%) of IF appear more sensitive than 10 mg (71.88%) doses of IF while maintaining a similar safety profile. Mixing fluorescein with double distilled water instead of CSF or saline may decrease waiting times before fluorescein can be identified and increase its safety profile.
Intrathecal fluorescein may play an important role in the identification of CSF leak site during endoscopic repair.
颅底缺陷可导致蛛网膜下腔的脑脊液（CSF）漏出到鼻窦腔，称为 CSF 鼻漏。出现 CSF 鼻漏的患者常需要手术修复，通常采用内窥镜进行。手术干预的成功高度依赖于对漏口位置的准确识别。通过在手术前经腰椎引流管给予鞘内荧光素（IF），可以增强识别。本系统评价的目的是更好地描述 IF 给药的益处和局限性。
系统搜索了记录 IF 用于 CSF 漏定位的文献。对该搜索的结果进行了初步审查，然后对选定文本进行全文评估，并根据预定的选择标准进行最终纳入。主要结局是 IF 给药在识别 CSF 漏口方面的特异性和敏感性。次要结局包括给药技术和安全性数据。
共有 25 项研究代表了 3801 例 IF 给药，符合纳入标准。当以小于 50mg 的剂量缓慢注射长达 30 分钟时，IF 给药导致的并发症很少。与 10mg（71.88%）剂量的 IF 相比，总剂量为 25mg（92.36%）的 IF 似乎更敏感，同时保持相似的安全性。将荧光素与双蒸水混合而不是 CSF 或生理盐水，可能会减少等待时间，直到可以识别出荧光素，并增加其安全性。
鞘内荧光素在经内窥镜修复时识别 CSF 漏口的位置可能起着重要作用。
