Update on the Effect of Lumbar Drains on Cerebrospinal Fluid Leak Rates following Endonasal Skull Base Surgery
Eric Wang, Paul Gardner, Carl Snyderman, Philippe Lavigne, Omar Ahmed
Introduction: High-flow intraoperative cerebrospinal fluid (CSF) leaks are associated with increased risk of post-operative CSF leaks despite multilayered reconstruction with vascularized tissue. A recent randomized controlled trial (RCT) examining the use of peri-operative lumbar drains (LD) in high-risk skull base defects identified a significant reduction in post-operative CSF leak incidence (21.2% vs. 8.2%; p=0.017).
Objective: This study was conducted to assess the efficacy of the selective use of CSF diversion, for patients with intraoperative CSF leaks involving endoscopic endonasal approaches (EEA) to the skull base.
Methods: Consecutive EEA to the skull base from a pre-RCT cohort and post-RCT cohort were compared. The following case characteristics were examined: patient age, body mass index (BMI), rate of revision surgery, tumor histology, use of CSF diversion, and vascularized reconstruction. The primary measured outcome was post-operative CSF leak.
Results: The pre-RCT cohort included 85 patients and the post-RCT cohort, 89 patients, with dural defects in either the anterior or posterior cranial fossa (pituitary and parasellar excluded). Between the cohorts, there were no differences in patient age (p=0.69), BMI (p=0.14), revision surgery (p=0.91), malignant vs. benign pathology (p=0.21), and vascularized reconstruction (p=0.71). However, there was a significant reduction in the incidence of post-operative CSF leak in the post-RCT cohort (24.7% vs. 10.1%; p=0.011).
Conclusions: The integration of selective CSF diversion into the reconstructive algorithm, as suggested by the previously published RCT, improved post-operative CSF leak rates in patients with anterior or posterior cranial fossa defects.