ENDOSCOPIC IDENTIFICATION OF CSF LEAKS US ING INTRATHECAL FLUORESCEIN- A REPORT ON 925 CASES

Background: For more than 35 years intrathecal fluorescein has been us ed for identification of cerebrospinal fluid leaks. Whereas some autho rs apply this technique routinely and with excellent results, signific ant complications have also been reported, sparking considerable contr oversy. At the Graz University ENT Department intrathecal sodium fluor escein has been routinely used for more than 25 years and is considere d a significant help. Material and methods: In a retrospective study d ata of 925 patients who underwent a diagnostic fluorescein test during the period from 1970-1995 at our department were evaluated. The techn iques of preparation and intrathecal application of sodium fluorescein are described, as are the techniques of endoscopic diagnostic and int raoperative 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 hav e 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 conc entrations of fiuorescein. False positive results are not possible wit h this technique; false negative findings can be present in 1-7 percen t of cases, however. Conclusion: Our results demonstrate that the use of intrathecal fluroescein can be an extremely helpful diagnostic tech nique involving minimal risk.