Utility of Intrathecal Fluorescein in Transmastoid Repair of Temporal Encephaloceles
- 1Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- 2Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Abstract
Objectives:: To assess the safety and efficacy of intrathecal fluorescein administration during transmastoid repair of temporal lobe encephaloceles and identify predictors for intraoperative fluorescein identification.
Methods:: This was a retrospective case-control study of consecutive adult patients with temporal lobe encephaloceles repaired via transmastoid approach from October 2012 to October 2024 at a single tertiary academic medical center. Medical records of qualifying patients were searched for demographics, diagnostic workup, disease characteristics, and intraoperative and postoperative outcomes. Analysis incorporated the Wilcoxon rank-sum, Pearson’s X2, and Fisher’s exact tests, along with unadjusted Kaplan-Meier estimates. Outcomes included encephalocele recurrence and symptomatic resolution rates, fluorescein complications, and rates and predictors of intraoperative fluorescein identification.
Results:: 38 patients met inclusion criteria (age 59.8 + 11.9 years, BMI 35.8 + 8.7 kg/m2, 23 [60.5%] female). Recurrence (0% vs 11.5%, P = .54) and symptom resolution (83.3% vs 88.5%, P = .64) rates did not differ between patients who received and did not receive intrathecal fluorescein. No fluorescein-related complications were reported. Fluorescein was intraoperatively detected in six-twelfths cases, yielding a sensitivity of 50%. No demographic or clinical variables, including higher BMI, history of prior encephalocele, and size of largest defect, were associated with intraoperative fluorescein identification.
Conclusions:: Intrathecal fluorescein administration preliminarily appears to be a safe adjunctive tool to identify the leak source in the transmastoid repair of temporal lobe encephaloceles, but its risk-benefit ratio remains up for debate. Higher-powered studies are necessary to explore its utility in specific circumstances and to determine which patients may benefit most.
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BibTeX
@article{shah2026utility,
title = {{Utility of Intrathecal Fluorescein in Transmastoid Repair of Temporal Encephaloceles}},
author = {Keshav V. Shah and Kevin Wong and Kim Le and Randall James Harley and Christian Jung and Tiffany Hwa and Michael J. Ruckenstein and Douglas C. Bigelow},
journal = {The Annals of Otology, Rhinology, and Laryngology},
year = {2026},
month = jul,
doi = {10.1177/00034894261470543},
url = {https://doi.org/10.1177/00034894261470543},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Utility of Intrathecal Fluorescein in Transmastoid Repair of Temporal Encephaloceles
AU - Keshav V. Shah
AU - Kevin Wong
AU - Kim Le
AU - Randall James Harley
AU - Christian Jung
AU - Tiffany Hwa
AU - Michael J. Ruckenstein
AU - Douglas C. Bigelow
PY - 2026
DA - 2026/07/20
JO - The Annals of Otology, Rhinology, and Laryngology
DO - 10.1177/00034894261470543
UR - https://doi.org/10.1177/00034894261470543
AB - Objectives:: To assess the safety and efficacy of intrathecal fluorescein administration during transmastoid repair of temporal lobe encephaloceles and identify predictors for intraoperative fluorescein identification. Methods:: This was a retrospective case-control study of consecutive adult patients with temporal lobe encephaloceles repaired via transmastoid approach from October 2012 to October 2024 at a single tertiary academic medical center. Medical records of qualifying patients were searched for demographics, diagnostic workup, disease characteristics, and intraoperative and postoperative outcomes. Analysis incorporated the Wilcoxon rank-sum, Pearson’s X2, and Fisher’s exact tests, along with unadjusted Kaplan-Meier estimates. Outcomes included encephalocele recurrence and symptomatic resolution rates, fluorescein complications, and rates and predictors of intraoperative fluorescein identification. Results:: 38 patients met inclusion criteria (age 59.8 + 11.9 years, BMI 35.8 + 8.7 kg/m2, 23 [60.5%] female). Recurrence (0% vs 11.5%, P = .54) and symptom resolution (83.3% vs 88.5%, P = .64) rates did not differ between patients who received and did not receive intrathecal fluorescein. No fluorescein-related complications were reported. Fluorescein was intraoperatively detected in six-twelfths cases, yielding a sensitivity of 50%. No demographic or clinical variables, including higher BMI, history of prior encephalocele, and size of largest defect, were associated with intraoperative fluorescein identification. Conclusions:: Intrathecal fluorescein administration preliminarily appears to be a safe adjunctive tool to identify the leak source in the transmastoid repair of temporal lobe encephaloceles, but its risk-benefit ratio remains up for debate. Higher-powered studies are necessary to explore its utility in specific circumstances and to determine which patients may benefit most.
SN - 0003-4894
SN - 1943-572X
ER -