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. 2025 Aug;135(8):2696-2701.
doi: 10.1002/lary.32135. Epub 2025 Mar 20.

Rapid Intrathecal Fluorescein Injection During Cerebrospinal Fluid Leak Repair Is Safe and Effective

Hussein Mackie  1 , Jacob G Eide  2 , Abdul Yassin-Kassab  1 , Carl Wilson  3 , Amrita Ray  4 , Adam M Robin  5 , Karam Asmaro  5 , Jack P Rock  5 , John R Craig  4
Affiliations

Rapid Intrathecal Fluorescein Injection During Cerebrospinal Fluid Leak Repair Is Safe and Effective

Hussein Mackie et al. Laryngoscope. 2025 Aug.

Abstract

Objective: Intrathecal fluorescein (IF) is effective for localizing nasal cerebrospinal fluid (CSF) leaks along the skull base during endoscopic exploration, with largest studies reporting sensitivities ranging from 66%-93%. Due to reports of intraoperative and postoperative neurologic complications such as seizures and paralysis, surgeons often dilute the fluorescein and inject it intrathecally slowly over a variable amount of time. However, no study has assessed whether rapid IF administration causes the aforementioned risks or whether it affects its accuracy in identifying CSF leaks intraoperatively.

Methods: A prospective study was conducted from 2015 to 2024, where all patients undergoing endoscopic exploration and/or repair of CSF rhinorrhea had 0.1 mL of 10% fluorescein (10 mg) mixed with 3-5 mL of patients' CSF injected rapidly via the lumbar drain over a few seconds.

Results: Of the 82 included patients, the mean age was 53.8 ± 15.2 years, and 84% were female. Sixty-nine patients underwent successful endoscopic CSF leak repairs, and 13 had negative endoscopic explorations. Rapid IF injection was 80% sensitive (20% false negative rate) and 100% specific for identifying CSF leaks, and it caused no seizures, paralysis, or other neurologic complications.

Conclusion: Compared to prior reports of slow low-dose IF injection for CSF leak localization, rapid IF injection yielded similar efficacy (80% sensitivity) with no IF-related complications. Rapid IF injection was safe and effective but should be corroborated by future studies.

Keywords: cerebrospinal fluid leak; endoscopic skull base surgery; intrathecal fluorescein; meningocele; seizure.

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References

    1. G. M. Oakley, J. A. Alt, R. J. Schlosser, R. J. Harvey, and R. R. Orlandi, “Diagnosis of Cerebrospinal Fluid Rhinorrhea: An Evidence‐Based Review With Recommendations,” International Forum of Allergy & Rhinology 6, no. 1 (2016): 8–16.
    1. R. Seth, K. Rajasekaran, M. S. Benninger, and P. S. Batra, “The Utility of Intrathecal Fluorescein in Cerebrospinal Fluid Leak Repair,” Otolaryngology and Head and Neck Surgery 143, no. 5 (2010): 626–632.
    1. J. P. Flynn, A. Pavelonis, L. Ledbetter, et al., “The Utility of Computed Tomography and Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leak,” American Journal of Rhinology & Allergy 34, no. 3 (2020): 342–347.
    1. K. Jolly, K. K. Gupta, A. Banota, and S. K. Ahmed, “The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks,” American Journal of Rhinology & Allergy 35, no. 6 (2021): 879–884.
    1. J. P. Radabaugh, K. Asi, Z. Y. Jiang, et al., “Assessing the Utility of Intrathecal Fluorescein in Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks,” International Forum of Allergy & Rhinology 12, no. 7 (2022): 967–970.

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