The efficacy and safety of intrathecal fluorescein in endoscopic cerebrospinal fluid leak repair -a systematic review

Background: Effective management of cerebrospinal fluid (CSF) leaks can reduce significant associated morbidity. Intrathecal fluorescein (IF) may be a valuable intra-operative adjunct to localise leak sites. Recent reports have demonstrated low doses of IF to be safe, however, no internationally accepted dose of IF has been agreed. Objective: To assess the efficacy and safety of IF used in the endoscopic management of anterior skull base CSF fistulae. Methods: A systematic review and descriptive analysis were performed of all published data in accordance to PRISMA guidelines. Results: There were 18 included articles giving a total of 335 procedures where IF was used. Doses of IF ranged from 10mg -150mg. IF positively identified the site of CSF fistula in 88.7% of cases (n = 297). There was a total of 25 reported peri-operative complications in all included studies (7.5%) with 5.1% (n = 17) potentially related to IF use. Of these, the complication rate was 3.9% at low IF doses ( < 50mg) and 80.0% at higher doses ( > 50mg). Conclusion: Our review demonstrates that IF is effective at localising CSF fistulae with most significant complications being related to doses > 50mg. We therefore propose that there is a potential for the licensing of IF in this field. Doses < 50mg have consistently been shown to be safe while still maintaining effective localisation rates. Based on the most common doses used in this group, we recommend utilisation of a dosing below 50mg, with the most frequent range being between 10-30mg. (C) 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.

Automated summary

This study aimed to assess the efficacy and safety of intrathecal fluorescein (IF) used in the endoscopic management of anterior skull base cerebrospinal fluid (CSF) fistulae. The results showed that IF was effective in localizing CSF fistulae, with the most significant complications associated with higher doses (>50mg). Therefore, it is recommended to use low doses of IF (<50mg) in this field, with a frequent range of 10-30mg.