Intraoperative Visualization of Flow in Direct Cerebrospinal Fluid-Venous Fistulas Using Intrathecal Fluorescein.
Oper Neurosurg (Hagerstown)
; 24(5): e336-e341, 2023 05 01.
Article
em En
| MEDLINE
| ID: mdl-37068025
ABSTRACT
BACKGROUND:
Cerebrospinal fluid-venous fistulas (CVFs) are a rare cause of spontaneous intracranial hypotension. Intraoperatively, CVFs are not readily identifiable and difficult to differentiate from normal veins.OBJECTIVE:
To assess the utility of intrathecal fluorescein injection intraoperatively to visualize and identify the CVF.METHODS:
We report a case series of patients treated surgically for a CVF. After surgical exposure, we injected intrathecal fluorescein (5-10 mg) through a lumbar catheter, which we placed immediately before surgery.RESULTS:
Four patients with spontaneous intracranial hypotension with a suspected CVF underwent surgical ligation with adjunctive intrathecal fluorescein application. Intraoperative fluorescein injection confirmed the presence of a CVF in 3 cases. In 2 cases, we observed rapid fluorescein filling of a single epidural vein constituting the CVF. Other epidural vessels did not fill with fluorescein. In 1 case, fluorescein helped to identify a residual CVF after previous incomplete embolization. In the fourth case, no CVF was found intraoperatively. By contrast, a meningeal nerve root diverticulum was visualized, wrapped, and clipped.CONCLUSION:
We demonstrate for the first time the direct intraoperative visualization of CVF using intrathecal fluorescein. CVF can be identified intraoperatively using fluorescein dye, which can be a valuable adjunct for the surgeon confronted with this disease.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Rinorreia de Líquido Cefalorraquidiano
/
Hipotensão Intracraniana
/
Fístula
Tipo de estudo:
Etiology_studies
Limite:
Humans
Idioma:
En
Revista:
Oper Neurosurg (Hagerstown)
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Alemanha