Canales MM, Morales CGM

Language: Spanish
References: 10
Page: 83-87
PDF size: 623.57 Kb.

ABSTRACT

Background: It has been reported that topical intranasal fluorescein (TIF) leads to 100% sensitivity and specificity in diagnosis of cerebrospinal fluid fistula (CSFF).
Objective: To determine reliability of topical intranasal fluorescein to detect cerebrospinal fluid (CSF) and confirm CSF fistula.
Participants and method: We gathered 10 samples of CSF obtained for motives not related to this study and without pathology, and 10 samples of nasal secretions (NS). A drop of each sample of CSF and NS was set on filter paper, and a drop of each sample of CSF was mixed with NS and set on filter paper. We applied fluorescein to each sample as it would be done intranasal in a patient with suspected CSFF. A change in color of sample was observed as fluorescein was applied. Five otolaryngologists were recruited, and we showed them 3 samples labeled as “CSF + fluorescein”, “nasal secretions + fluorescein”, and “CSF with nasal secretions + fluorescein”. Then we showed the 30 samples to the five otolaryngologists and asked them for a diagnosis for each. The number of right answers was determined for each person and average of right answers calculated. Results were compared with those expected by chance, using Chi test.
Results: The results observed while using topical intranasal fluorescein to discriminate between cerebrospinal fluid and nasal secretions did not differ with those expected by chance, thereby it was impossible to differentiate nasal secretions from cerebrospinal fluid by observing color after application of fluorescein.
Conclusions: Topical intranasal fluorescein cannot confirm or exclude cerebrospinal fluid fistula. TIF has no role in study protocols of cerebrospinal fluid fistula.

REFERENCES

1. Cummings C. Otolaryngology – Head & Neck Surgery. 4th ed. Mosby, 2006.

2. Bailey B, et al. Head & Neck Surgery – Otolaryngology. 4th ed. Lippincott Williams & Wilkins, 2006.

3. Saafan M, Ragab S, Albirmawy O. Topical intranasal fluorescein: the missing partner in algorithms of cerebrospinal fluid fistula detection. Laryngoscope 2006;116:1158-1161.

4. Jones M, Reino T, Gnoy A, et al. Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye. Am J Rhinol 2000;14(2):93-96.

5. Basu D, Haughey B, Hartman J. Determinants of success in endoscopic cerebrospinal fluid leak repair. Otolaryngol Head Neck Surg 2006;135:769-773.

6. Stammberger H, Greistorfer K, Wolf G, et al. Surgical occlusion of cerebrospinal fistulas of the anterior skull base using intrathecal sodium fluorescein. Laryngorhinootologie 1997;76(10):595-607.

7. Anari S, Waldron M, Carrie S. Delayed absence seizure: a complication of intrathecal fluorescein injection. A case report and literature review. Auris Nasus Larynx 2007;34(4):515-518.

8. Trindade-Porto C, Alonso-Llamazares A, Robledo T, et al. Fluorescein induced adverse reaction. Allergy 1999;54:1230.

9. Landis E, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174.

10. Fluorescein – Compound Summary. En: http://pubchem.ncbi.nlm.nih.gov