What is the evidence for postoperative lumbar drains in endoscopic repair of <scp>CSF</scp> leaks?

Bakhsheshian, Joshua; Hwang, Michelle S.; Friedman, Michael

doi:10.1002/lary.25379

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…There have been several other reviews that dealt with LD placement for the management of CSF leaks; however, these studies were not as comprehensive and included patients treated for idiopathic and/or traumatic CSF leaks. 19,24,32,33 We chose to use stringent inclusion criteria because postoperative outcomes from EEA skull base reconstruction are substantially different from other types of CSF leaks because they more frequently result in large dural defects and high-flow CSF leaks [34][35][36][37] Results of a number of studies indicated that these types of leaks may be more amenable to vascularized tissue repair. 17,[38][39][40] As such, we only reported on contemporary repair techniques, specifically, pedicled flap and/or multilayered reconstructions, to permit a more-focused analysis that is generalizable and relevant to current skull base practices.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21] In addition, there is growing evidence that shows a lack of benefit in LDs with respect to CSF leak repair secondary to iatrogenic, traumatic, or idiopathic causes. [22][23][24] Given these evolving factors, we aimed to evaluate the literature to determine the utility of CSF diversion in endoscopic skull base surgery with respect to postoperative CSF leak rates when using modern reconstructive techniques. Specifically, we aimed to address defects created as part of tumor resection of the anterior skull base.…”

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confidence: 99%

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Role of Lumbar Drains in Contemporary Endonasal Skull Base Surgery: Meta-Analysis and Systematic Review

D’Anza

Tien

Stokken

et al. 2016

Am J Rhinol�Allergy

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Role of Lumbar Drains in Contemporary Endonasal Skull Base Surgery: Meta-Analysis and Systematic Review

D’Anza

Tien

Stokken

et al. 2016

Am J Rhinol�Allergy

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“…Bakhsheshian et al found that several studies evaluating LD in the endoscopic endonasal repair of CSF leaks indicated no clear benefit of LD. 5 However, they made no mention of the size or location of the defects and none of these studies were randomized. A recent review of LD usage in endoscopic skull base surgery concluded that there is much variation regarding LD and there is no definitive protocol.…”

Section: Anteriormentioning

confidence: 99%

“…Indeed, the lack of significance for suprasellar defects is consistent with the majority of the literature, consisting of nonrandomized series, largely composed of sellar or suprasellar tumors that did not demonstrate a need for LD. 1,5,8,13,24 Dural defect size was measured intraoperatively in 106 patients but was not routinely performed early in our series. We found a strong trend toward significance between size and leak rate (p = 0.03).…”

Section: Anteriormentioning

confidence: 99%

Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial

Zwagerman¹,

Wang

Shin³

et al. 2019

Journal of Neurosurgery

145

142

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OBJECTIVEBased on a null hypothesis that the use of short-term lumbar drainage (LD) after endoscopic endonasal surgery (EES) for intradural pathology does not prevent postoperative CSF leaks, a trial was conducted to assess the effect of postoperative LD on postoperative CSF leak following standard reconstruction.METHODSA prospective, randomized controlled trial of lumbar drain placement after endoscopic endonasal skull base surgery was performed from February 2011 to March 2015. All patients had 3-month follow-up data. Surgeons were blinded to which patients would or would not receive the drain until after closure was completed. An a priori power analysis calculation assuming 80% of power, 5% postoperative CSF leak rate in the no-LD group, and 16% in the LD group determined a planned sample size of 186 patients. A routine data and safety check was performed with every 50 patients being recruited to ensure the efficacy of randomization and safety. These interim tests were run by a statistician who was not blinded to the arms they were evaluating. This study accrued 230 consecutive adult patients with skull base pathology who were eligible for endoscopic endonasal resection. Inclusion criteria (high-flow leak) were dural defect greater than 1 cm2 (mandatory), extensive arachnoid dissection, and/or dissection into a ventricle or cistern. Sixty patients were excluded because they did not meet the inclusion criteria. One hundred seventy patients were randomized to either receive or not receive a lumbar drain.RESULTSOne hundred seventy patients were randomized, with a mean age of 51.6 years (range 19–86 years) and 38% were male. The mean BMI for the entire cohort was 28.1 kg/m2. The experimental cohort with postoperative LD had an 8.2% rate of CSF leak compared to a 21.2% rate in the control group (odds ratio 3.0, 95% confidence interval 1.2–7.6, p = 0.017). In 106 patients in whom defect size was measured intraoperatively, a larger defect was associated with postoperative CSF leak (6.2 vs 2.9 cm2, p = 0.03). No significant difference was identified in BMI between those with (mean 28.4 ± 4.3 kg/m2) and without (mean 28.1 ± 5.6 kg/m2) postoperative CSF leak (p = 0.79). Furthermore, when patients were grouped based on BMI < 25, 25–29.9, and > 30 kg/m2, no difference was noted in the rates of CSF fistula (p = 0.97).CONCLUSIONSAmong patients undergoing intradural EES judged to be at high risk for CSF leak as defined by the study’s inclusion criteria, perioperative LD used in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.Clinical trial registration no.: NCT03163134 (clinicaltrials.gov).

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“…Acute symptomatic hydrocephalus in SAH 12 Spinal cord-protective strategy in open and endovascular thoracic aortic repair for patients at high risk of spinal cord injury 9,24,[38][39][40] Active CSF leak (due to craniofacial trauma) 41 or those at risk for CSF leak during skull base procedures [42][43][44] ; however, lumbar drains do not prevent postoperative CSF leaks 44,45 Facilitate intraoperative brain relaxation 27 and intraoperative exposure 46 CSF indicates cerebrospinal fluid; CT, computed tomography; GCS, Glasgow Coma Score; ICH, intracerebral hemorrhage; IVH, intraventricular hemorrhage; rTPA, recombinant tissue plasminogen activator; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; TBI, traumatic brain injury.…”

Section: Lumbar Drainsmentioning

confidence: 99%

Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Lele

Hoefnagel

Schloemerkemper

et al. 2017

Journal of Neurosurgical Anesthesiology

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External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains.

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What is the evidence for postoperative lumbar drains in endoscopic repair of CSF leaks?

Cited by 11 publications

References 4 publications

Role of Lumbar Drains in Contemporary Endonasal Skull Base Surgery: Meta-Analysis and Systematic Review

Role of Lumbar Drains in Contemporary Endonasal Skull Base Surgery: Meta-Analysis and Systematic Review

Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial

Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

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