Continuous lumbar drainage for the prevention and management of perioperative cerebrospinal fluid leakage

Background: Cerebrospinal fluid (CSF) leak is an unfortunate, yet well-recognized complication of skull base fractures, skull base surgeries, and variety of spinal procedures. Continuous lumbar drainage (CLD) of leaking CSF has shown a high success rate with minimal morbidities in handling CSF leak in these patients. Therefore, we conducted this study to illustrate the efficacy of CLD as a prophylactic and therapeutic method for CSF leakage with the assessment of clinical outcome and early postoperative sequel. Materials and Methods: In the period from January to December 2017, patients with traumatic or postoperative CSF leak and those susceptible for postoperative CSF leak as skull base and spinal intradural surgeries at the Neurosurgery Department, Fayoum University, were included in our study. Results: A total of 20 eligible patients were included in the study. All patients showed successful cessation of CSF leakage at different durations of CLD. Fifteen patients showed excellent results; four showed good results; and one showed fair results. Besides a minimal pneumocephalus, headache was the most common presenting complication in our population, which occurred to all patients. Six patients had vomiting beside headache, whereas two patients experienced vomiting and nausea in addition to headache. There were neither mortalities nor life-threatening complications noted; however, a superficial wound infection occurred in a single case. Conclusion: CLD is a simple, safe, and efficient method in the management of CSF leakage at operative sites, CSF rhinorrhea, and CSF otorrhea of various etiologies.

Key-words:

Cerebrospinal fluid - leak - lumbar drain

Financial support and sponsorship

Nil.

Publikationsverlauf

Artikel online veröffentlicht:
09. September 2022

• References

• 1 Coiteiro D, Távora L, Antunes JL. Spontaneous cerebrospinal fluid fistula through the clivus: Report of two cases. Neurosurgery 1995;37:826-8.
• 2 Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am 1989;71:984-7.
• 3 McCallum J, Maroon JC, Jannetta PJ. Treatment of postoperative cerebrospinal fluid fistulas by subarachnoid drainage. J Neurosurg 1975;42:434-7.
• 4 Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery 1992;30:241-5.
• 5 Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg 2001;25:1062-6.
• 6 Bell RB, Dierks EJ, Homer L, Potter BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 2004;62:676-84.
• 7 Graf CJ, Gross CE, Beck DW. Complications of spinal drainage in the management of cerebrospinal fluid fistula. J Neurosurg 1981;54:392-5.
• 8 Wahlig JB, Welch WC, Kang JD, Jungreis CA. Cervical intrathecal catheter placement for cerebrospinal fluid drainage: Technical case report. Neurosurgery 1999;44:419-21.
• 9 Dalgic A, Okay HO, Gezici AR, Daglioglu E, Akdag R, Ergungor MF. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: Closed lumbar drainage system. Minim Invasive Neurosurg 2008;51:154-7.
• 10 Jung H, Shah A, Ajlan A. Perioperative cerebrospinal fluid diversion utilizing lumbar drains in transsphenoidal surgery. J Neurol Disord 2014;2:150. Available from: https://www.omicsonline.org/pdfdownload.php?download=open-access/perioperative-cerebrospinal-fluid-diversion-utilizing-lumbar-drains-in-transsphenoidal-surgery-2329-6895.1000150.pdf.
• 11 Huang CI, Huang MC, Chen IH, Lee LS. Diverse applications of continuous lumbar drainage of cerebrospinal fluid in neurosurgical patients. Ann Acad Med Singapore 1993;22:456-8.
• 12 Roland PS, Marple BF, Meyerhoff WL, Mickey B. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg 1992;107:564-9.
• 13 Mansy A, Kersh A, Eissa E. Role of the external lumbar drain in management of CSF leak during or after transsphenoidal surgery. Egypt J Neurol Psychiatry Neurosurg 2010;47:483-8.
• 14 Ozisik P, Roth J, Beni-Adani L, Constantini S. Continuous spinal drain following endoscopic third ventriculostomy: A proposal to change the definition of failure. Childs Nerv Syst 2011;27:1973-8.
• 15 Mehta GU, Oldfield EH. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. J Neurosurg 2012;116:1299-303.
• 16 Ransom ER, Palmer JN, Kennedy DW, Chiu AG. Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol 2011;1:173-7.
• 17 Laws ER Jr., de Los Reyes K, Rincon-Torroella J. Lumbar drains in transsphenoidal surgery. J Neurosurg 2013;118:480-1.
• 18 Kaptain GJ, Vincent DA, Laws ER Jr. Cranial base reconstruction after transsphenoidal surgery with bioabsorbable implants. Neurosurgery 2001;48:232-3.
• 19 Sade B, Mohr G, Frenkiel S. Management of intra-operative cerebrospinal fluid leak in transnasal transsphenoidal pituitary microsurgery: Use of post-operative lumbar drain and sellar reconstruction without fat packing. Acta Neurochir (Wien) 2006;148:13-8.
• 20 Seiler RW, Mariani L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: A 10-year experience with 376 patients. J Neurosurg 2000;93:762-5.
• 21 Grady RE, Horlocker TT, Brown RD, Maxson PM, Schroeder DR. Neurologic complications after placement of cerebrospinal fluid drainage catheters and needles in anesthetized patients: Implications for regional anesthesia. Mayo perioperative outcomes group. Anesth Analg 1999;88:388-92.