Abstract：
OBJECTIVE: The intraoperative detection of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery is critical to ensure watertight sealed defects. Intrathecal fluorescein (ITF) is a valuable adjunct to intraoperative investigation. Hence, our aim is to summarize the evidence of the efficacy of ITF as an accurate diagnostic modality and reconstruction guide for non-congenital skull base defects.
METHODS: Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis.
RESULTS: Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications.
CONCLUSIONS: ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.
METHODS: Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis.
RESULTS: Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications.
CONCLUSIONS: ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.
摘要：
目的：内窥镜颅底手术中脑脊液（CSF）泄漏的术中检测对于确保水密性密封缺陷至关重要。鞘内注射荧光素（ITF）是术中检查的有价值的辅助手段。因此，我们的目的是总结ITF作为非先天性颅底缺损的准确诊断方式和重建指南的有效性的证据.
方法：使用CochraneCentral，MEDLINE,和Embase数据库，我们确定了在非先天性CSF漏泄中使用ITF的研究,这些研究发表至2023年11月.采用STATA18软件进行Meta分析。
结果：14项研究符合纳入标准，其中7项研究纳入荟萃分析.1898名患者使用了ITF（90.3%），检出率为88.1%。在ITF浓度为5％和10％的非先天性CSF泄漏的总体检出率具有统计学意义的合并效应大小为2.6（95％CI=2.25，2.95），而在将ITF与其他替代放射学测试进行比较时，无统计学意义,平均差异为0.88(95%CI=-0.4,2.16).此外，合并的患病率在与ITF相关的并发症方面具有统计学意义,效应大小为0.6(95%CI=0.39,0.82),表明60%接受ITF的患者会经历至少一种测量的并发症.
结论：ITF被认为是定位颅底缺损的有效工具。然而,将ITF与其他替代放射学测试进行比较时,没有显著结果.因此，如果指示ITF干预，应根据临床需要仔细选择患者。
方法：使用CochraneCentral，MEDLINE,和Embase数据库，我们确定了在非先天性CSF漏泄中使用ITF的研究,这些研究发表至2023年11月.采用STATA18软件进行Meta分析。
结果：14项研究符合纳入标准，其中7项研究纳入荟萃分析.1898名患者使用了ITF（90.3%），检出率为88.1%。在ITF浓度为5％和10％的非先天性CSF泄漏的总体检出率具有统计学意义的合并效应大小为2.6（95％CI=2.25，2.95），而在将ITF与其他替代放射学测试进行比较时，无统计学意义,平均差异为0.88(95%CI=-0.4,2.16).此外，合并的患病率在与ITF相关的并发症方面具有统计学意义,效应大小为0.6(95%CI=0.39,0.82),表明60%接受ITF的患者会经历至少一种测量的并发症.
结论：ITF被认为是定位颅底缺损的有效工具。然而,将ITF与其他替代放射学测试进行比较时,没有显著结果.因此，如果指示ITF干预，应根据临床需要仔细选择患者。
