title: Is the use of topical fluorescein helpful for management of CSF leakage?
abstract: OBJECTIVE
  We aimed to evaluate the effectiveness of topical intranasal fluorescence application together with high-resolution computed tomography and magnetic resonance imaging and/or magnetic resonance cisternography for the preoperative diagnosis of cerebrospinal fluid (CSF) leakage and for intraoperative localization of CSF fistulas. We also assessed postoperative recurrence.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Twenty-four cases underwent endonasal endoscopic repair for CSF leakage. Following intranasal topical application of fluorescein 10% to the middle turbinate-cribriform plate region and anterior wall of the sphenoid sinus, a color change of the fluorescein from yellow-brown to green was accepted as evidence of CSF leakage. A nasoseptal flap, collagen matrix, or fascia lata and septal cartilage graft were used for reconstruction of the CSF fistula.
  
  
  RESULTS
  The use of topical fluorescein application was helpful in diagnosing CSF rhinorrhea preoperatively and locating the CSF fistula intraoperatively. One case had both ethmoid roof and sphenoid sinus defects, and this case underwent a second operation for closure of the sphenoid defect. All CSF leakages were successfully repaired by endoscopic endonasal surgery using a nasoseptal flap.
  
  
  CONCLUSIONS
  Cases with traumatic CSF leakage pose a higher risk of meningitis than the cases with spontaneous CSF leakage. Topical application of fluorescein is highly specific and sensitive in identifying preoperative, intraoperative, and postoperative CSF leakage. It is a simple, quick, and sensitive technique. The surgeon should be vigilant for multiple defects.
authors.affiliation: Department of Otolaryngology, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey. kayhanozturk@selcuk.edu.tr
authors.forename: Kayhan
authors.initials: K
authors.lastname: Ozturk
authors.forename: Hakan
authors.initials: H
authors.lastname: Karabagli
authors.forename: Serap
authors.initials: S
authors.lastname: Bulut
authors.forename: Meryem
authors.initials: M
authors.lastname: Egilmez
authors.forename: Mutlu
authors.initials: M
authors.lastname: Duran
mesh_terms: D000281:Administration, Intranasal; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D003287:Contrast Media / Q000494:pharmacology; D004724:Endoscopy / Q000379:methods; D005260:Female; D019793:Fluorescein / Q000494:pharmacology; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019793:Fluorescein