Is topical fluorescein that effective in endoscopic CSF leak closure?

Purpose: Several diagnostic modalities are used to detect CSF leaks. Intraoperative use of intrathecal fluorescein can help to detect and localize a CSF leak simultaneously. However, it is not FDA approved, the application is invasive and has serious complications. Topical fluorescein is reported to be a safe and sensitive alternative to ITF. In this study, we aimed to evaluate the effectiveness of topical fluorescein in CSF leak closure.
Methods: This retrospective study includes 27 consecutive patients (19 women, 8 men) who underwent endoscopic endonasal CSF leak closure using topical fluorescein, between 2011 and 2017.
Results: In two patients, radiologic studies false positively locate the defect. β2 transferrin and topical fluorescein tests were positive in these patients. Both cases needed a second operation.
Conclusion: If radiologic studies fail to locate the defect properly, topical fluorescein only confirms the CSF leak, but the defect cannot be located anatomically intraoperatively.