The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery
Abstract This study assesses the efficacy of preoperative lumbar drain (LD) placement prior to elective open cranial and endoscopic anterior skull base (ASB) surgery in reducing postoperative cerebrospinal fluid (CSF) leak. A retrospective review of 93 patients who underwent LD placement at our inst...
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Georg Thieme Verlag KG
2013-01-01
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Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1331022 |
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doaj-c8854fe1147149f1930d7b8bcdf502082020-11-25T02:38:08ZengGeorg Thieme Verlag KGJournal of Neurological Surgery Reports2193-63582193-63662013-01-01740100100910.1055/s-0032-1331022The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base SurgeryPaul D. Ackerman0Drew A. Spencer1Vikram C. Prabhu2Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United StatesDepartment of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United StatesDepartment of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United StatesAbstract This study assesses the efficacy of preoperative lumbar drain (LD) placement prior to elective open cranial and endoscopic anterior skull base (ASB) surgery in reducing postoperative cerebrospinal fluid (CSF) leak. A retrospective review of 93 patients who underwent LD placement at our institution between 2006 and 2011 was performed. Of these patients, 43 underwent elective LD placement prior to ASB surgery; 2 patients had evidence of CSF rhinorrhea prior to surgery, and 41 had no evidence of a preoperative CSF leak. Of those 41 patients, 2 developed CSF rhinorrhea (2/41= 4.9%) as a result of surgery—all in our endoscopic patient population (N = 21; 2/21= 9.5%). No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20). Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail. Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1331022cerebrospinal fluidlumbar draincraniotomyanterior skull baseendoscopic |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul D. Ackerman Drew A. Spencer Vikram C. Prabhu |
spellingShingle |
Paul D. Ackerman Drew A. Spencer Vikram C. Prabhu The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery Journal of Neurological Surgery Reports cerebrospinal fluid lumbar drain craniotomy anterior skull base endoscopic |
author_facet |
Paul D. Ackerman Drew A. Spencer Vikram C. Prabhu |
author_sort |
Paul D. Ackerman |
title |
The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery |
title_short |
The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery |
title_full |
The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery |
title_fullStr |
The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery |
title_full_unstemmed |
The Efficacy and Safety of Preoperative Lumbar Drain Placement in Anterior Skull Base Surgery |
title_sort |
efficacy and safety of preoperative lumbar drain placement in anterior skull base surgery |
publisher |
Georg Thieme Verlag KG |
series |
Journal of Neurological Surgery Reports |
issn |
2193-6358 2193-6366 |
publishDate |
2013-01-01 |
description |
Abstract
This study assesses the efficacy of preoperative lumbar drain (LD) placement prior to elective open cranial and endoscopic anterior skull base (ASB) surgery in reducing postoperative cerebrospinal fluid (CSF) leak. A retrospective review of 93 patients who underwent LD placement at our institution between 2006 and 2011 was performed. Of these patients, 43 underwent elective LD placement prior to ASB surgery; 2 patients had evidence of CSF rhinorrhea prior to surgery, and 41 had no evidence of a preoperative CSF leak. Of those 41 patients, 2 developed CSF rhinorrhea (2/41= 4.9%) as a result of surgery—all in our endoscopic patient population (N = 21; 2/21= 9.5%). No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20). Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail. Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement. |
topic |
cerebrospinal fluid lumbar drain craniotomy anterior skull base endoscopic |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1331022 |
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