[Endoscopic detection of cerebrospinal fluid fistulas with a fluorescence technique. Report of experiences with over 925 cases]

Abstract

Background: For more than 35 years intrathecal fluorescein has been used for identification of cerebrospinal fluid leaks. Whereas some authors apply this technique routinely and with excellent results, significant complications have also been reported, sparking considerable controversy. At the Graz University ENT Department intrathecal sodium fluorescein has been routinely used for more than 25 years and is considered a significant help.

Material and methods: In a retrospective study data of 925 patients who underwent a diagnostic fluorescein test during the period from 1970-1995 at our department were evaluated. The techniques of preparation and intrathecal application of sodium fluorescein are described, as are the techniques of endoscopic diagnostic and intraoperative identification of fluorescein stained CSF.

Results: There were three complications during 925 fluorescein tests that resulted in grand mal seizures after suboccipital application. Since 1990, we have discontinued the use of suboccipital punctures, and in more than 250 consecutive cases since then we have not seen any complications. Side effects and complications reported in literature are attributable to three main factors; application of too large quantities of fluorescein, of unsuitable fluorescein preparations, and of excessively high concentrations of fluorescein. False positive results are not possible with this technique; false negative findings can be present in 1-7 percent of cases, however.

Conclusion: Our results demonstrate that the use of intrathecal fluorescein can be an extremely helpful diagnostic technique involving minimal risk.