No abstract

Cerebrospinal fl uid (CSF) fi stulae have been encountered by otolaryngologists often since the advent of modern endoscopic sinus surgery, otologic surgery, and skull base surgery. Treatment of CSF leaks may include bed rest, head-of-bed elevation, stool softeners, external spinal fl uid drainage, and surgery. External CSF drainage is accomplished via a lumbar spinal drain. Placement of spinal drains is often performed by neurosurgeons and anesthetists. A few otolaryngologists have been trained in the placement and management of lumbar drains, but at most otolaryngology training institutions, education in lumbar drains is not provided. However, in some circumstances, it may fall to an otolaryngologist to accomplish the task. We believe that every otolaryngologist, from the generalist in private practice to the academic neuro-otologic surgeon, should understand the proper technique for the insertion and management of a lumbar drain. Otolaryngologists should be familiar with the physiologic properties of CSF, the methods used to diagnose fi stulae, and the techniques used to repair leaks. External spinal drainage is an important element in the management of CSF fi stulae, and it has been used in treating perilymphatic fi stulae and "gushers." Much controversy surrounds its routine use. Otolaryngologists need to understand the risks, benefi ts, and outcomes of spinal drain use in order to decide which patients may benefi t from this procedure.