Use of a Hypodense Sodium Fluorescein Solution for the Endoscopic Repair of Rhinogenic Cerebrospinal Fluid Fistulae

Abstract

Background Hypodense fluorescein solution can be used intrathecally to facilitate and accelerate the identification of the fistulous site. Methods Eighteen patients were submitted for nasal endoscopic correction of rhinogenic cerebrospinal fluid fistulas after their identification with a hypodense sodium fluorescein solution. Results Intrathecal injection of hypodense fluorescein permitted a rapid and safe identification of the leak and did not present significant side effects. The fistulous site was identified in all patients, and the time needed for staining was <30 minutes in all cases. Surgery was successful in 88% of the patients after only one intervention, with the rate reaching 100% after a secondary intervention in cases of recurrence. Conclusion Intrathecal injection of a hypodense sodium fluorescein solution permits a more precise, rapid, and safe endoscopic approach, with no need to place the patient in the Trendelenburg position or to wait for a long period of time before starting the surgical procedure.