Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery

Kyle P. Allen, Brandon Isaacson, Patricia Purcell, Joe Walter Kutz, Peter S. Roland

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: To determine the efficacy of lumbar drainage in managing cerebrospinal fluid (CSF) leak after lateral skull base surgery. Study Design: Retrospective case review. Seting: Academic tertiary referral center. Patients: Patients who had a lumbar subarachnoid drain placed after a lateral skull base procedure between July 1999 and February 2010 were included. Interventions: Patients were identified by searching medical records for lateral skull base approach Current Procedural Terminology codes. The following variables were recorded for each subject: diagnosis, type of lateral skull base operation, duration of lumbar drainage, need for revision surgery, and presence of meningitis. Main Outcome Measure: Successful cessation of postoperative CSF leakage. Results: Five hundred eight charts were reviewed, and 63 patients were identified who received a lumbar drain after a lateral skull base operation. The most common diagnosis was acoustic neuroma in 61.9%. The most common skull base approaches were the translabyrinthine, middle fossa, and transpetrosal approaches. Approximately 60.3% of patients had CSF rhinorrhea, 23.8% had an incisional leak, and 14.3% had otorrhea. The mean duration of lumbar drainage was 4.6 days. Forty eight (76.2%) study subjects had resolution of their CSF leak with lumbar drainage. Fifteen patients (23.8%) required revision surgery to stop the CSF leak. Lumbar drainage was successful in 90% of leaks after the translabyrinthine approach but in only 50% of those undergoing a suboccipital approach, which was a statistically significant difference. Conclusion: Postoperative CSF leaks after lateral skull base surgery can be managed with a lumbar subarachnoid drain in a majority of cases but is more successful after the translabyrinthine than the suboccipital approach. Recurrent CSF leaks after lumbar drainage is likely to require a revision operation.

Original languageEnglish (US)
Pages (from-to)1522-1524
Number of pages3
JournalOtology and Neurotology
Volume32
Issue number9
DOIs
StatePublished - Dec 2011

Fingerprint

Skull Base
Drainage
Reoperation
Current Procedural Terminology
Cerebrospinal Fluid Rhinorrhea
Acoustic Neuroma
Cerebrospinal Fluid Leak
Meningitis
Tertiary Care Centers
Medical Records
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems
  • Medicine(all)

Cite this

Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. / Allen, Kyle P.; Isaacson, Brandon; Purcell, Patricia; Kutz, Joe Walter; Roland, Peter S.

In: Otology and Neurotology, Vol. 32, No. 9, 12.2011, p. 1522-1524.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the efficacy of lumbar drainage in managing cerebrospinal fluid (CSF) leak after lateral skull base surgery. Study Design: Retrospective case review. Seting: Academic tertiary referral center. Patients: Patients who had a lumbar subarachnoid drain placed after a lateral skull base procedure between July 1999 and February 2010 were included. Interventions: Patients were identified by searching medical records for lateral skull base approach Current Procedural Terminology codes. The following variables were recorded for each subject: diagnosis, type of lateral skull base operation, duration of lumbar drainage, need for revision surgery, and presence of meningitis. Main Outcome Measure: Successful cessation of postoperative CSF leakage. Results: Five hundred eight charts were reviewed, and 63 patients were identified who received a lumbar drain after a lateral skull base operation. The most common diagnosis was acoustic neuroma in 61.9{\%}. The most common skull base approaches were the translabyrinthine, middle fossa, and transpetrosal approaches. Approximately 60.3{\%} of patients had CSF rhinorrhea, 23.8{\%} had an incisional leak, and 14.3{\%} had otorrhea. The mean duration of lumbar drainage was 4.6 days. Forty eight (76.2{\%}) study subjects had resolution of their CSF leak with lumbar drainage. Fifteen patients (23.8{\%}) required revision surgery to stop the CSF leak. Lumbar drainage was successful in 90{\%} of leaks after the translabyrinthine approach but in only 50{\%} of those undergoing a suboccipital approach, which was a statistically significant difference. Conclusion: Postoperative CSF leaks after lateral skull base surgery can be managed with a lumbar subarachnoid drain in a majority of cases but is more successful after the translabyrinthine than the suboccipital approach. Recurrent CSF leaks after lumbar drainage is likely to require a revision operation.",
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