Hussein Mackie, Jacob G Eide, Abdul Yassin-Kassab, Carl Wilson, Amrita Ray, Adam M Robin, Karam Asmaro, Jack P Rock, John R Craig
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引用次数: 0
Abstract
Objective: Intrathecal fluorescein (IF) is effective for localizing nasal cerebrospinal fluid (CSF) leaks along the skull base during endoscopic exploration, with largest studies reporting sensitivities ranging from 66%-93%. Due to reports of intraoperative and postoperative neurologic complications such as seizures and paralysis, surgeons often dilute the fluorescein and inject it intrathecally slowly over a variable amount of time. However, no study has assessed whether rapid IF administration causes the aforementioned risks or whether it affects its accuracy in identifying CSF leaks intraoperatively.
Methods: A prospective study was conducted from 2015 to 2024, where all patients undergoing endoscopic exploration and/or repair of CSF rhinorrhea had 0.1 mL of 10% fluorescein (10 mg) mixed with 3-5 mL of patients' CSF injected rapidly via the lumbar drain over a few seconds.
Results: Of the 82 included patients, the mean age was 53.8 ± 15.2 years, and 84% were female. Sixty-nine patients underwent successful endoscopic CSF leak repairs, and 13 had negative endoscopic explorations. Rapid IF injection was 80% sensitive (20% false negative rate) and 100% specific for identifying CSF leaks, and it caused no seizures, paralysis, or other neurologic complications.
Conclusion: Compared to prior reports of slow low-dose IF injection for CSF leak localization, rapid IF injection yielded similar efficacy (80% sensitivity) with no IF-related complications. Rapid IF injection was safe and effective but should be corroborated by future studies.
目的：鞘内荧光素（IF）可有效定位内镜探查过程中沿颅底的鼻脑脊液（CSF）泄漏，最大的研究报告灵敏度为66%-93%。由于术中和术后神经系统并发症的报道，如癫痫发作和瘫痪，外科医生经常稀释荧光素，并在不同的时间内缓慢注入鞘内。然而，没有研究评估快速给药是否会导致上述风险，或者是否会影响术中识别脑脊液泄漏的准确性。方法：2015年至2024年进行前瞻性研究，所有接受内镜探查和/或修复脑脊液鼻漏的患者在几秒钟内将0.1 mL 10%荧光素（10 mg）与3-5 mL患者脑脊液混合，经腰椎引流孔快速注射。结果：82例患者平均年龄53.8±15.2岁，女性占84%。69例患者经内镜成功修复脑脊液泄漏，13例内镜检查阴性。快速IF注射对脑脊液渗漏的敏感性为80%（假阴性率为20%），特异性为100%，且未引起癫痫发作、瘫痪或其他神经系统并发症。结论：与先前报道的慢速低剂量注射干扰素用于脑脊液泄漏定位相比，快速注射干扰素具有相似的疗效（80%的敏感性），无干扰素相关并发症。快速注射干扰素是安全有效的，但需要进一步的研究来证实。证据等级：4；
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
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