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Pete S Batra - One of the best experts on this subject based on the ideXlab platform.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVE: To evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care medical center. SUBJECTS AND METHODS: Subjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg). RESULTS: A total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 percent (95% CI 46.3%-100%), respectively. The false-negative rate was 26.2 percent (95% CI 15.8%-43.5%). Localization of the leak site was greater when Fluorescein-colored CSF was visualized (100% vs 81.3%; P = 0.035). When Fluorescein-colored CSF was not visualized intraoperatively, recurrence rates were 31.3 percent versus 9.7 percent when Fluorescein coloration was seen, although this finding was not statistically significant (P = 0.10). CONCLUSION: The use of IF facilitates the accurate localization of CSF leaks and may assist the surgeon in confirming a watertight closure. The lack of intraoperative Fluorescein visualization should not rule out the presence of CSF leak, as evidenced by a false-negative rate of 26.2 percent.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVETo evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks.STUDY DESIGNCase series with chart review.SETTINGTertiary-care medical center.SUBJECTS AND METHODSSubjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg).RESULTSA total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 pe...
Rahul Seth - One of the best experts on this subject based on the ideXlab platform.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVE: To evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care medical center. SUBJECTS AND METHODS: Subjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg). RESULTS: A total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 percent (95% CI 46.3%-100%), respectively. The false-negative rate was 26.2 percent (95% CI 15.8%-43.5%). Localization of the leak site was greater when Fluorescein-colored CSF was visualized (100% vs 81.3%; P = 0.035). When Fluorescein-colored CSF was not visualized intraoperatively, recurrence rates were 31.3 percent versus 9.7 percent when Fluorescein coloration was seen, although this finding was not statistically significant (P = 0.10). CONCLUSION: The use of IF facilitates the accurate localization of CSF leaks and may assist the surgeon in confirming a watertight closure. The lack of intraoperative Fluorescein visualization should not rule out the presence of CSF leak, as evidenced by a false-negative rate of 26.2 percent.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVETo evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks.STUDY DESIGNCase series with chart review.SETTINGTertiary-care medical center.SUBJECTS AND METHODSSubjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg).RESULTSA total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 pe...
Vijay K Anand - One of the best experts on this subject based on the ideXlab platform.
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safety of low dose intrathecal Fluorescein in endoscopic cranial base surgery
Neurosurgery, 2007Co-Authors: Dimitris G Placantonakis, Abtin Tabaee, Vijay K Anand, David H Hiltzik, Theodore H SchwartzAbstract:Objective Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful closure after endoscopic cranial base surgery. Intrathecal injection of Fluorescein is quite useful in identifying CSF leaks. However, complications have been reported with various doses and the technique has fallen out of favor. We explored the safety of low-dose intrathecal Fluorescein administered to patients undergoing endoscopic cranial base surgery. Methods A retrospective chart review and postoperative patient survey were performed. The nature and incidence of complications and subjective complaints were recorded in 54 patients who underwent endoscopic, endonasal approaches to the anterior cranial base and received intrathecal Fluorescein after premedication with dexamethasone and diphenhydramine. Results Intraoperative CSF leak was identified with Fluorescein in 46.3% of the patients and helped determine the reconstruction technique. Postoperative CSF leak occurred in 9.3% of the patients and resolved with lumbar drainage. There were no seizures. Most side effects were nonspecific, transient, and likely not caused by Fluorescein including malaise (57.4%), headache (51.9%), dizziness (31.5%), or nausea/vomiting (24.1%). Three patients (5.6%) experienced persistent subjective lower extremity weakness (n = 2) and numbness (n = 2) postoperatively; however, two of them had undergone lumbar drainage. Conclusion Low-dose injection of intrathecal Fluorescein after premedication with steroid and antihistamine agents is generally safe. Most symptoms are nonspecific and transient, likely caused by the surgery or lumbar drainage. However, Fluorescein should be administered with some caution because it may be responsible for occasional lower extremity weakness and numbness.
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intrathecal Fluorescein in endoscopic skull base surgery
Otolaryngology-Head and Neck Surgery, 2007Co-Authors: Abtin Tabaee, Dimitris G Placantonakis, Theodore H Schwartz, Vijay K AnandAbstract:OBJECTIVES: Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal Fluorescein, however, is unknown.STUDY DESIGN: A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal Fluorescein. A possible correlation between intraoperative Fluorescein identification and postoperative CSF leak was analyzed.RESULTS: 61 patients underwent surgery for a variety of lesions including pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%). Seven (19.4%) of the 37 patients with intraoperative Fluorescein leak experienced postoperative CSF leak compared to 0 of the 24 patients who did not have intraoperative Fluorescein leak (P = 0.02). All cases of CSF leak resolved with lumbar drainage alone.CONCLUSIONS: The lack of intraoperative Fluorescein leak-age correlates strongly with a low risk for postoperative C...
Theodore H Schwartz - One of the best experts on this subject based on the ideXlab platform.
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safety of low dose intrathecal Fluorescein in endoscopic cranial base surgery
Neurosurgery, 2007Co-Authors: Dimitris G Placantonakis, Abtin Tabaee, Vijay K Anand, David H Hiltzik, Theodore H SchwartzAbstract:Objective Intraoperative identification of cerebrospinal fluid (CSF) leakage is critical in successful closure after endoscopic cranial base surgery. Intrathecal injection of Fluorescein is quite useful in identifying CSF leaks. However, complications have been reported with various doses and the technique has fallen out of favor. We explored the safety of low-dose intrathecal Fluorescein administered to patients undergoing endoscopic cranial base surgery. Methods A retrospective chart review and postoperative patient survey were performed. The nature and incidence of complications and subjective complaints were recorded in 54 patients who underwent endoscopic, endonasal approaches to the anterior cranial base and received intrathecal Fluorescein after premedication with dexamethasone and diphenhydramine. Results Intraoperative CSF leak was identified with Fluorescein in 46.3% of the patients and helped determine the reconstruction technique. Postoperative CSF leak occurred in 9.3% of the patients and resolved with lumbar drainage. There were no seizures. Most side effects were nonspecific, transient, and likely not caused by Fluorescein including malaise (57.4%), headache (51.9%), dizziness (31.5%), or nausea/vomiting (24.1%). Three patients (5.6%) experienced persistent subjective lower extremity weakness (n = 2) and numbness (n = 2) postoperatively; however, two of them had undergone lumbar drainage. Conclusion Low-dose injection of intrathecal Fluorescein after premedication with steroid and antihistamine agents is generally safe. Most symptoms are nonspecific and transient, likely caused by the surgery or lumbar drainage. However, Fluorescein should be administered with some caution because it may be responsible for occasional lower extremity weakness and numbness.
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intrathecal Fluorescein in endoscopic skull base surgery
Otolaryngology-Head and Neck Surgery, 2007Co-Authors: Abtin Tabaee, Dimitris G Placantonakis, Theodore H Schwartz, Vijay K AnandAbstract:OBJECTIVES: Reconstruction following endoscopic skull base surgery requires a high degree of success to avoid the morbidity of postoperative cerebrospinal fluid (CSF) leak. The impact on outcomes of CSF visualization with intrathecal Fluorescein, however, is unknown.STUDY DESIGN: A retrospective review of patients undergoing endoscopic skull base surgery with intrathecal Fluorescein. A possible correlation between intraoperative Fluorescein identification and postoperative CSF leak was analyzed.RESULTS: 61 patients underwent surgery for a variety of lesions including pituitary adenoma (55.7%), encephalocele (14.8%), and meningioma (9.8%). Seven (19.4%) of the 37 patients with intraoperative Fluorescein leak experienced postoperative CSF leak compared to 0 of the 24 patients who did not have intraoperative Fluorescein leak (P = 0.02). All cases of CSF leak resolved with lumbar drainage alone.CONCLUSIONS: The lack of intraoperative Fluorescein leak-age correlates strongly with a low risk for postoperative C...
Michael S Benninger - One of the best experts on this subject based on the ideXlab platform.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVE: To evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care medical center. SUBJECTS AND METHODS: Subjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg). RESULTS: A total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 percent (95% CI 46.3%-100%), respectively. The false-negative rate was 26.2 percent (95% CI 15.8%-43.5%). Localization of the leak site was greater when Fluorescein-colored CSF was visualized (100% vs 81.3%; P = 0.035). When Fluorescein-colored CSF was not visualized intraoperatively, recurrence rates were 31.3 percent versus 9.7 percent when Fluorescein coloration was seen, although this finding was not statistically significant (P = 0.10). CONCLUSION: The use of IF facilitates the accurate localization of CSF leaks and may assist the surgeon in confirming a watertight closure. The lack of intraoperative Fluorescein visualization should not rule out the presence of CSF leak, as evidenced by a false-negative rate of 26.2 percent.
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the utility of intrathecal Fluorescein in cerebrospinal fluid leak repair
Otolaryngology-Head and Neck Surgery, 2010Co-Authors: Rahul Seth, Karthik Rajasekaran, Michael S Benninger, Pete S BatraAbstract:OBJECTIVETo evaluate the utility of intrathecal Fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks.STUDY DESIGNCase series with chart review.SETTINGTertiary-care medical center.SUBJECTS AND METHODSSubjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg).RESULTSA total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, Fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without Fluorescein coloration, and five (10.6%) had neither clear nor Fluorescein-colored CSF visualized. Sensitivity and specificity for Fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 pe...