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J Neurol Surg B Skull Base 2023; 84(01): 017-023
DOI: 10.1055/a-1722-4433
Original Article

Detection of Cerebrospinal Fluid Leaks Using the Endoscopic Fluorescein Test in the Postoperative Period following Pituitary and Ventral Skull Base Surgery

Peter A. Benedict
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
,
Joseph R. Connors 
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
,
Micah R. Timen
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
,
Nupur Bhatt
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
,
Richard A. Lebowitz
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
,
Donato R. Pacione
2   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Seth M. Lieberman
1   Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
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Abstract

Objective Diagnosis of cerebrospinal fluid (CSF) leaks is sometimes challenging in the postoperative period following pituitary and ventral skull base surgery. Intrathecal fluorescein (ITF) may be useful in this setting.

Design Retrospective chart review.

Setting Tertiary care center.

Methods and Participants All patients who underwent pituitary and ventral skull base surgery performed by a single rhinologist between January 2017 and March 2020 were included. There were 103 patients identified. Eighteen patients received 20 ITF injections due to clinical suspicion for CSF leak during the postoperative period without florid CSF rhinorrhea on clinical exam. Computed tomography scans with new or increasing intracranial air and intraoperative findings were used to confirm CSF leaks. Clinical courses were reviewed for at least 6 months after initial concern for leak as the final determinate of CSF leak.

Main Outcome Measures Specificity and safety of ITF.

Results Eleven (61%) ITF patients were female and 7 (39%) were male. Average patient age was 52.50 ± 11.89. There were six patients with confirmed postoperative CSF leaks, 3 of whom had evaluations with ITF. ITF use resulted in 2 true positives, 1 false negative, 17 true negatives, and 0 false positives. ITF sensitivity was 67%, specificity was 100%, and positive and negative predictive values were 100 and 94.4%, respectively. There were no adverse effects from ITF use.

Conclusions Existing modalities for detecting postoperative CSF leaks suffer from suboptimal sensitivity and specificity, delayed result reporting, or limited availability. ITF represents a specific and safe test with potential utility in the postoperative setting.

Keywords

cerebrospinal fluid leak - fluorescein - postoperative period - diagnostic tests

Note

Abstract was presented as a Virtual Poster, September 12th 2020, American Rhinologic Society (Originally in Boston, MA).




Publication History

Received: 09 June 2021

Accepted: 13 December 2021

Accepted Manuscript online:
16 December 2021

Article published online:
18 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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