ENT video case: sphenoid sinus cerebrospinal fluid leak. Intrathecal fluorescein (IF): Intrathecal Fluorescein (IF): Injecting fluorescein dye into the CSF via lumbar puncture can allow for accurate identification of a skull-base fistula site during endoscopy. The use of IF for this purpose is off label and lacks clear guidelines as to the best dosage and procedure for the safest and most effective results. A search of the use of IF in the setting of CSF leak confirmation and localization identified 15 relevant studies. Of these, 14 were cross-sectional studies and 1 used mechanism-based reasoning. They reported that IF identified the CSF leak site in 46% to 100% of cases. In the United States, the lowest dose and concentration is typically used, which is most commonly 0.5 to 2 mL of 0.5% fluorescein (2.5 to 10 mg) diluted in CSF.
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