Abstract：
The main causes for cerebrospinal fluid (CSF) leaks are known to be traumatic, iatrogenic, neoplastic, a meningoencephalocele, congenital bone defects, and spontaneous. Off-label intrathecal administration of fluorescein is widely used to localize a CSF leak. Complications are rare and low dose administration is described to be safe. In this case report, we present a case of a patient, who showed a CSF leak due to an encephalocele. Low dose fluorescein was applied intrathecally via lumbar catheter, the CSF leaks could be identified, and multilayered closure was performed. Postoperatively, the patient presented with motor and sensory deficits in the lower limbs which regressed only partially within 2 months. A possible explanation may be an increased local concentration of fluorescein, possibly on the basis of a preexisting lumbar spinal canal stenosis. To our knowledge, this is the first case in which a dose as low as 20 mg of fluorescein (2% saline mixture) led to persisting paraplegia. Therefore, the potential benefits and risks of the intrathecal fluorescein use in the detection of a CSF leak have to be discussed comprehensively prior to surgery.
摘要：
已知脑脊液（CSF）泄漏的主要原因是创伤性的，医源性,肿瘤，脑膜脑膨出,先天性骨缺损,和自发的。荧光素的标记外鞘内给药广泛用于定位CSF泄漏。并发症很少见，低剂量给药被认为是安全的。在这个案例报告中,我们提出一个病人的病例,因为脑膨出而出现脑脊液漏.通过腰椎导管鞘内应用低剂量荧光素，脑脊液泄漏可以被识别，并进行多层闭合。术后,患者出现下肢运动和感觉缺陷，仅在2个月内部分消退。一个可能的解释可能是荧光素的局部浓度增加，可能是基于先前存在的腰椎管狭窄。据我们所知,这是第一个剂量低至20mg荧光素（2％盐水混合物）导致持续截瘫的病例。因此,术前必须全面讨论鞘内注射荧光素在脑脊液漏出检测中的潜在益处和风险.
