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Skull Base 2007; 17(2): 133-139
DOI: 10.1055/s-2007-970562
ORIGINAL ARTICLE

Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

Alexander G. Bien1 , Bradley Bowdino2 , Gary Moore1 , Lyal Leibrock2 [†]
  • 1Department of Otolaryngology-Head and Neck Surgery, The University of Nebraska Medical Center, Omaha, Nebraska
  • 2Department of Surgery, Division of Neurosurgery, The University of Nebraska Medical Center, Omaha, Nebraska
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Publikationsverlauf

Publikationsdatum:
27. Februar 2007 (online)

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Commentary “Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery”Skull Base 2007; 17(02): 139-139
DOI: 10.1055/s-2007-970563

ABSTRACT

Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula. Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension. Results: Between 1989 and 1994, 25/72 (35%) patients with no preoperative lumbar drain had a postoperative CSF leak. From 1995 to 2000, 9/78 (12%) patients with a preoperative lumbar drain had a CSF leak. This was a 23% decreased incidence of postoperative CSF leakage and a significant decrease in the probability (p < 0.001) of CSF leakage in patients treated with a preoperative lumbar drain. The comorbidities of diabetes, smoking, or hypertension did not increase the probability of a CSF leak (p = 0.43). Conclusions: A preoperatively placed lumbar drain can significantly lower the rate of postoperative CSF leakage after skull base surgery. The drain is a well-tolerated adjunct to dural closure and helps increase surgical exposure of the posterior fossa. The comorbidities of diabetes, smoking, or hypertension do not contribute to an increased rate of CSF leakage.

KEYWORDS

Cerebrospinal fluid fistula - lumbar drain - retrosigmoid - translabyrinthine

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1 Deceased.

Alexander G BienM.D. 

981225 Nebraska Medical Center

Omaha, NE 68198-1225

eMail: abien@unmc.edu