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Utilization of preoperative cerebrospinal fluid drain in skull base surgery.
MedLine Citation:
PMID:  17768443     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.dagger Lyal Leibrock M.D., F.A.C.S. is Deceased.
Authors:
Alexander G Bien; Bradley Bowdino; Gary Moore; Lyal Leibrock
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Skull base : official journal of North American Skull Base Society ... [et al.]     Volume:  17     ISSN:  1531-5010     ISO Abbreviation:  Skull Base     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-09-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101090660     Medline TA:  Skull Base     Country:  United States    
Other Details:
Languages:  eng     Pagination:  133-9     Citation Subset:  -    
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, The University of Nebraska Medical Center, Omaha, Nebraska.
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