In cerebrospinal fluid (CSF) leakage endoscopic repair, lumbar drains (LDs) were used in an attempt to increase success rates. To critically assess the relationship between use of LDs and recurrent leaks, we embarked on this randomized prospective study.
Methods
Patients undergoing CSF leak repair between 2000 and 2012 were randomized into two groups: 75 patients were managed without LDs and in the other group of 75 patients an LD was always placed. Different parameters were analyzed to identify their relationship with failures: occurrence of increased intracranial pressure (ICP), body mass index, smoking habits, existence of diabetes, chronic corticosteroid use, previous sinus surgery, etiology (traumatic, iatrogenic, or spontaneous leak), site, and size of the CSF leak.
Results
Success rate was 93% for the whole group. Patients managed with LDs attained 95% success rate and those without LD attained 92%; the difference is not significant (p = 0.2). The only factor predictive of recurrence is increased ICP: 77% success rate versus 97% for traumatic leaks and 96% for iatrogenic leaks. Recurrence rates were identical in the two groups with increased ICP, regardless of the use of a LD (23%).
Conclusion
In this study, success rates of CSF repair were not associated with the use of LDs. However, the small number of cases with high success rates precludes appropriate statistical analysis.
Get full access to this article
View all access options for this article.
References
1.
BanksCAPalmerJNChiuAG, Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg140:826–833, 2009.
2.
HarveyRJParmarPSacksR and ZanationAM. Endoscopic skull base reconstruction of large dural defects: A systematic review of published evidence. Laryngoscope122:452–459, 2012.
3.
LeeDHLimSC and JooYE. Treatment outcomes of endoscopic repairs of sinonasal cerebrospinal fluid leaks. J Craniofac Surg22:1266–1270, 2011.
4.
MattoxDE and KennedyDW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope100:857–862, 1990.
5.
SchickBIbingRBrorsD and DrafW.Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol110:142–147, 2001.
6.
GassnerHGPonikauJUSherrisDA and KernEB. CSF rhinorrhea: 95 consecutive surgical cases with long term follow-up at the Mayo Clinic. Am J Rhinol13:439–447, 1999.
7.
HegazyHMCarrauRLSnydermanCH, Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: A meta-analysis. Laryngoscope110:1166–1172, 2000.
8.
SchlosserRJ and BolgerWE. Nasal cerebrospinal fluid leaks: Critical review and surgical considerations. Laryngoscope114:255–265, 2004.
9.
RansomERPalmerJN and KennedyDW. Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol1:173–177, 2011.
10.
AnandVKMuraliRK and GlasgoldMJ. Surgical decisions in the management of cerebrospinal fluid rhinorrhoea. Rhinology33:212–218, 1995.
11.
GuidoLJ and PattersonRHJr.Focal neurological deficits secondary to intraoperative CSF drainage: Successful resolution with an epidural blood patch. Report of two cases. J Neurosurg45:348–351, 1976.
12.
PepperJPLinEMSullivanSE and MarentetteLJ. Perioperative lumbar drain placement: An independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery. Laryngoscope121:468–473, 2011.
13.
ForsytheAGuptaA and CohenSP. Retained intrathecal catheter fragment after spinal drain insertion. Reg Anesth Pain Med34:375–378, 2009.
14.
CaballeroNBhallaVStankiewiczJA and WelchKC. Effect of lumbar drain placement on recurrence of cerebrospinal rhinorrhea after endoscopic repair. Int Forum Allergy Rhinol2:222–226, 2012.
15.
WormaldPJ and McDonoghM.The bath-plug closure of anterior skull base cerebrospinal fluid leaks. Am J Rhinol17:299–305, 2003.
16.
HadadGBassagasteguyLCarrauRL, A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap. Laryngoscope116:1882–1886, 2006.
SchlosserRJWoodworthBAWilenskyEM, Spontaneous cerebrospinal fluid leaks: A variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol115:495–500, 2006.
19.
RehDDGalliaGLRamanathanM, Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks: Presentation of a novel technique. Am J Rhinol Allergy24:238–243, 2010.
20.
LeeTJHuangCCChuangCC and HuangSF. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: Ten-year experience. Laryngoscope114:1475–1481, 2004.
21.
CarrauRLSnydermanCH and KassamAB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope115:205–212, 2005.
22.
BerkerMAghayevKYücelT, Management of cerebrospinal fluid leak during endoscopic pituitary surgery. Auris Nasus Larynx40:373–378, 2013.
23.
RansomER and ChiuAG. Prevention and management of complications in intracranial endoscopic skull base surgery. Otolaryngol Clin North Am43:875–895, 2010.
24.
van AkenMOFeeldersRAde MarieS, Cerebrospinal fluid leakage during transsphenoidal surgery: Postoperative external lumbar drainage reduces the risk of meningitis. Pituitary7:89–93, 2004.
25.
SeniorBAJafriK and BenningerM.Safety and efficacy of endoscopic repair of CSF leaks and encephaloceles: A survey of the members of the American Rhinologic Society. Am J Rhinol15:21–25, 2001.
26.
CasianoRR and JassirD.Endoscopic cerebrospinal fluid rhinorrhea repair: Is a lumbar drain necessary?Otolaryngol Head Neck Surg121:745–750, 1999.
27.
KirtaneMVGauthamK and UpadhyayaSR. Endoscopic CSF rhinorrhea closure: Our experience in 267 cases. Otolaryngol Head Neck Surg132:208–212, 2005.
28.
YeoNKChoGSKimCJ, The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Acta Otolaryngol133:82–90, 2013.
29.
LindstromDRToohillRJLoehrlTA and SmithTL. Management of cerebrospinal fluid rhinorrhea: The Medical College of Wisconsin experience. Laryngoscope114:969–974, 2004.
30.
ZweigJLCarrauRLCelinSE, Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: Predictors of success. Otolaryngol Head Neck Surg123:195–201, 2000.
31.
WiseSKHarveyRJNealJG, Factors contributing to failure in endoscopic skull base defect repair. Am J Rhinol Allergy23:185–191, 2009.
32.
SchlosserRJWilenskyEMGradyMS and BolgerWE. Elevated intracranial pressure in spontaneous cerebrospinal fluid leaks. Am J Rhinol17:191–195, 2003.
33.
SchlosserRJWilenskyEMGradyMS, Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg130:443–448, 2004.
34.
SchlosserRJ and BolgerWE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: A clinical association. Am J Rhinol17:91–96, 2003.
35.
MirzaSThaperAMcClellandL and JonesNS. Sinonasal cerebrospinal fluid leaks: Management of 97 patients over 10 years. Laryngoscope115:1774–1777, 2005.
36.
WoodworthBAPrinceAChiuAG, Spontaneous CSF leaks: A paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg138:715–720, 2008.
37.
PsaltisAJSchlosserRJBanksCA, A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg147:196–203, 2012.
38.
BanksCAPalmerJNChiuAG, Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg140:826–833, 2009.
