Commentary “Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery”

Bien and colleagues present a retrospective analysis of preoperatively placed lumbar drains for intra- and postoperative CSF drainage. They conclude that lumbar drain placement dramatically diminished rates of wound CSF leakage. Although this study is limited by historical controls and its retrospective nature, the utility of CSF draining in the postoperative period deserves emphasis in the literature. In our own experience, we place lumbar drains preoperatively in nearly all posterior fossa tumor or vascular cases for intraoperative brain relaxation and postoperative wound healing. Usually drains are maintained in the intensive care unit (per our institution's protocol) for 3 postoperative days and are removed without a trial of closure. We agree that these drains are well tolerated, with nearly absent complication and infection rates. The theoretical risks of delayed postoperative mobilization and additional site of infection have not been borne out in our clinical experience. As a caveat to compulsive lumbar drain usage, it is important to differentiate preoperative obstructive hydrocephalus from tumor or vascular lesion, in which case preoperative ventriculostomy drain placement is the preferred choice.