Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye

The purpose of this paper is to describe a safe new technique for intraoper ative identification of the site of cerebrospinal fluid rhinorrhea. Cerebro spinal fluid (CSF) rhinorrhea after intracranial or intranasal surgery is a known potential complication with significant morbidity and mortality. It is currently accepted that endoscopic intranasal management of CSF rhinorrh ea is the preferred method of surgical repair, with higher success rates an d less morbidity than intracranial surgical repair in selected cases. Accur ate identification of the site of CSF leakage is necessary for a successful endoscopic surgical repair. Computer tomography (CT) with or without intra thecal contrast and preoperative nasal endoscopy are frequently used to pre operatively localize the site of the leak. Intrathecal fluorescein administ ered immediately before surgery has aided in the intraoperative identificat ion of the site of CSF leak in 25-64% of patients undergoing endoscopic rep air of CSF rhinorrhea in whom preoperative CT scanning and nasal endoscopy had not identified the site of CSF leak. Intrathecal fluorescein, however, has been associated with severe complications, such as lower extremity weak ness, numbness, generalized seizures, opisthotonus, and cranial nerve defic its. We present three cases of CSF rhinorrhea in which fluorescein was appl ied intranasally during the endoscopic surgical repair Ten percent fluoresc ein was applied to the nose with a cotton swab. Under endoscopic visualizat ion the fluorescein changed its fluorescent color from amber/yellow to a da rk green and was found streaming from high in the nasal cavity, which led t o accurate identification of the site of the CSF leak.