{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:22:59Z","timestamp":1794324179777,"version":"4.9.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>The intraoperative detection of CSF leaks during endonasal endoscopic skull base surgery is critical to preventing postoperative CSF leaks. Intrathecal fluorescein (ITF) has been used at varying doses to aid in the detection of intraoperative CSF leaks. However, the sensitivity and specificity of ITF at certain dosages is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prospective database of all endoscopic endonasal procedures was reviewed. All patients received 25 mg ITF diluted in 10 ml CSF and were pretreated with dexamethasone and Benadryl. Immediately after surgery, the operating surgeon prospectively noted if there was an intraoperative CSF leak and fluorescein was identified. The sensitivity, specificity, and positive and negative predictive power of ITF for detecting intraoperative CSF leak were calculated. Factors correlating with postoperative CSF leak were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 419 patients, 35.8% of patients did not show a CSF leak. Fluorescein-tinted CSF (true positive) was noted in 59.7% of patients and 0 false positives were encountered. CSF without fluorescein staining (false negative) was noted in 4.5% of patients. The sensitivity and specificity of ITF were 92.9% and 100%, respectively. The negative and positive predictive values were 88.8% and 100%, respectively. Postoperative CSF leaks only occurred in true positives at a rate of 2.8%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>ITF is extremely specific and very sensitive for detecting intraoperative CSF leaks. Although false negatives can occur, these patients do not appear to be at risk for postoperative CSF leak. The use of ITF may help surgeons prevent postoperative CSF leaks by intraoperatively detecting and confirming a watertight repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.12.jns14995","type":"journal-article","created":{"date-parts":[[2015,8,21]],"date-time":"2015-08-21T09:59:25Z","timestamp":1440151165000},"page":"621-626","source":"Crossref","is-referenced-by-count":58,"title":["Sensitivity and specificity of intrathecal fluorescein and white light excitation for detecting intraoperative cerebrospinal fluid leak in endoscopic skull base surgery: a prospective study"],"prefix":"10.3171","volume":"124","author":[{"given":"Shaan M.","family":"Raza","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matei A.","family":"Banu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Donaldson","sequence":"additional","affiliation":[{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay K.","family":"Anand","sequence":"additional","affiliation":[{"name":"Otolaryngology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore H.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Otolaryngology, and"},{"name":"Neurology and Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns14995","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.clineuro.2013.11.006","article-title":"Low-dose intrathecal fluorescein and etiology-based graft choice in endoscopic endonasal closure of CSF leaks","volume":"116","author":"Banu","year":"2014"},{"key":"b2-jns14995","series-title":"Am J Rhinol","doi-asserted-by":"publisher","first-page":"184","DOI":"10.2500\/ajr.2007.21.2972","article-title":"Use of a hypodense sodium fluorescein solution for the endoscopic repair of rhinogenic cerebrospinal fluid fistulae","volume":"21","author":"Demarco","year":"2007"},{"key":"b3-jns14995","series-title":"Acta Otorhinolaryngol Ital","first-page":"159","article-title":"Italian multi-centre study on intrathecal fluorescein for craniosinusal flstulae","volume":"28","author":"Felisati","year":"2008"},{"issue":"3 Suppl Operative","key":"b4-jns14995","series-title":"Neurosurgery","first-page":"ons150","article-title":"Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances","volume":"67","author":"Fraser","year":"2010"},{"key":"b5-jns14995","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1227\/01.NEU.0000368395.82329.C4","article-title":"Endoscopic endonasal transethmoidal transcribriform transfovea ethmoidalis approach to the anterior cranial fossa and skull base","volume":"66","author":"Greenfield","year":"2010"},{"key":"b6-jns14995","series-title":"Rev Laryngol Otol Rhinol (Bord)","first-page":"191","article-title":"A new technique for the use of intrathecal fluorescein in the repair of cerebrospinal fluid rhinorrhea using a hypodense diluent","volume":"122","author":"Guimar\u00e3es","year":"2001"},{"key":"b7-jns14995","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"967","DOI":"10.3171\/2009.10.JNS09157","article-title":"The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave","volume":"113","author":"Hofstetter","year":"2010"},{"key":"b8-jns14995","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e513","DOI":"10.1016\/j.wneu.2013.06.005","article-title":"Incidence and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary surgery using intrathecal fluorescein","volume":"82","author":"Jakimovski","year":"2014"},{"key":"b9-jns14995","series-title":"Arch Iran Med","first-page":"264","article-title":"The use of low-dose intrathecal fluorescein in endoscopic repair of cerebrospinal fluid rhinorrhea","volume":"16","author":"Javadi","year":"2013"},{"key":"b10-jns14995","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/00005537-200402000-00016","article-title":"Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States","volume":"114","author":"Keerl","year":"2004"},{"key":"b11-jns14995","series-title":"Laryngoscope","first-page":"921","article-title":"Method for the identification and localization of cerebrospinal fluid, rhinorrhea and otorrhea","volume":"70","author":"Kirchner","year":"1960"},{"key":"b12-jns14995","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"400","DOI":"10.3171\/jns.2007.106.3.400","article-title":"Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions","volume":"106","author":"Laufer","year":"2007"},{"key":"b13-jns14995","series-title":"Am J Rhinol","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/194589240201600104","article-title":"Endoscopic management of cerebrospinal fluid leaks","volume":"16","author":"Lund","year":"2002"},{"key":"b14-jns14995","series-title":"World Neurosurg","first-page":"186","article-title":"The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned","volume":"82","author":"Mascarenhas","year":"2013"},{"key":"b15-jns14995","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"765","DOI":"10.3171\/jns.1978.48.5.0765","article-title":"Spectrum of complications in the use of intrathecal fluorescein","volume":"48","author":"Moseley","year":"1978"},{"key":"b16-jns14995","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"661","DOI":"10.3171\/2013.4.JNS13124","article-title":"Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery","volume":"119","author":"Patel","year":"2013"},{"issue":"3 Suppl","key":"b17-jns14995","series-title":"Neurosurgery","first-page":"161","article-title":"Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery","volume":"61","author":"Placantonakis","year":"2007"},{"key":"b18-jns14995","series-title":"Int Forum Allergy Rhinol","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/alr.20097","article-title":"Endoscopic endonasal approaches to the cavernous sinus","volume":"2","author":"Raithatha","year":"2012"},{"key":"b19-jns14995","series-title":"Orbit","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3109\/01676830.2010.543004","article-title":"Surgical approaches to the orbital apex: comparison of endoscopic endonasal and transcranial approaches using a novel 3D endoscope","volume":"30","author":"Roth","year":"2011"},{"key":"b20-jns14995","series-title":"Clin Neurosurg","first-page":"226","article-title":"The endoscopic endonasal transsphenoidal approach to the suprasellar cistern","volume":"54","author":"Schwartz","year":"2007"},{"key":"b21-jns14995","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.otohns.2010.07.011","article-title":"The utility of intrathecal fluorescein in cerebrospinal fluid leak repair","volume":"143","author":"Seth","year":"2010"},{"key":"b22-jns14995","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.otohns.2006.11.012","article-title":"Intrathecal fluorescein in endoscopic skull base surgery","volume":"137","author":"Tabaee","year":"2007"},{"key":"b23-jns14995","series-title":"Laryngorhinootologie","first-page":"588","article-title":"Endoscopic detection of cerebrospinal fluid fistulas with a fluorescence technique. Report of experiences with over 925 cases","volume":"76","author":"Wolf","year":"1997"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/124\/3\/article-p621.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/124\/3\/article-p621.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/124\/3\/article-p621.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T04:58:11Z","timestamp":1709960291000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/124\/3\/article-p621.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3]]},"references-count":23,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2014.12.jns14995","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3]]}}}