Usefulness of topical intranasal fluorescein for localization of anterior skull base fluid fistulas: a systematic review

OBJECTIVE. This study evaluates the available evidence on the usefulness of topical intranasal fluorescein in diagnosing and localizing nasal cerebrospinal fluid (CSF) leakage. MATERIAL AND METHODS. A systematic review of the literature was conducted to investigate the usefulness and safety of intranasal topical fluorescein for locating nasal cerebrospinal fluid fistulas, following PRISMA guidelines. Articles were searched in databases including Scopus, PubMed, and ScienceDirect, (“Intranasal Fluorescein” AND “Cerebrospinal Fluid Fistula”) OR (“Intranasal Fluorescein” AND “CSF Fistula”) in the publications with no time restriction, in the English language. The chosen articles were evaluated with the Newcastle-Ottawa Scale. A table was used to summarize the results. RESULTS. The 6 included studies on topical intranasal fluorescein to locate CSF fistulas show high effectiveness and safety, with success rates close to 100%. However, limitations include small samples, lack of control groups, and the need for more comparative studies. The methodological quality of the studies is mostly moderate. CONCLUSION. Intranasal topical fluorescein is an effective and safe method to locate intranasal cerebrospinal fluid leaks, with high diagnostic accuracy. It is a less invasive and more economical option compared to techniques such as intrathecal fluorescein. More controlled research is needed to confirm its effectiveness.