Efficacy and Role of Intrathecal Fluorescein for Detection of Defect Site for Treatment of Cerebrospinal Fluid Rhinorrhea

Abstract

Background/Objectives:  Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant mortality and morbidity. 90% of post-traumatic rhinorrheas stop conservatively, 10% of post-traumatic, spontaneous, and post-operative rhinorrhea need surgical repair. Fluorescein is helpful in the detection of CSF rhinorrhea peroperatively. Material and Methods:  A descriptive case series was conducted at the Department of Neurosurgery, PINS Lahore in a single unit by a single surgical team. 62 patients were enrolled who met the inclusion and exclusion criteria. The lumbar drain was passed at L4 – L5 level and 0.1 ml of 25% sodium Fluorescein was diluted in 10 ml of CSF. The endoscope passed through the nostril and the leakage point was detected by yellowish-green fluid coming out of the rent under endoscope. After surgery, the patients were followed up after two weeks to observe the efficacy. Post-stratification was done through a chi-square test. Results:  The mean age of the patients was 42.85 years. The most common leakage was found from cribriform plate followed by lateral lamella & sphenoid sinus. Gender difference, leakage site, and age of the patients did not have significant effects on the results of using fluorescein dye for detecting the rent. The benefit of using the dye was 79%. Conclusion:  This study indicated that intrathecal fluorescein is a highly effective and beneficial approach for pinpoint localization of CSF defect, particularly very minute defects, and plays an important role in the successful treatment of CSF rhinorrhea.