Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review

OBJECTIVE: This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak. METHODS: A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications. RESULTS: After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series. CONCLUSION: Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.