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  • Lumbar Drains Do Not Affect Incidence of Postoperative Cerebrospinal Fluid Leak or Infection in Recent Posterior Fossa Tumor Patients

    Final Number:

    Laura A. Snyder MD; Samuel Kalb MD; Luis Perez-Orribo; Kris A. Smith MD; Peter Nakaji; Robert F. Spetzler MD; Randall W. Porter MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Lumbar drains are often placed just prior to posterior fossa craniotomies for tumor resection to improve intraoperative exposure as well as to prevent postoperative cerebrospinal fluid (CSF) leaks. As wound closure techniques, grafts, and dural sealants have improved over time, we sought to determine if lumbar drains still made a significant contribution in decreasing postoperative CSF leaks in recent posterior fossa tumor patients.

    Methods: A retrospective review evaluated 120 patients who received posterior fossa craniotomies for tumor resection from 2004 to 2011. Patients’ charts were evaluated for demographics, comorbidities, type of tumor, surgical approach, placement of preoperative lumbar drain, incidence of postoperative CSF leak, and surgical site infection.

    Results: Of the 120 patients evaluated, 50 patients (41.7%) received retrosigmoid craniotomies, 48 (40%) translabyrinthine, 9 (7.5%) far lateral, 3 (2.5%) suboccipital, 3 (2.5%) combined retrosigmoid/translabyrinthine, 3 (2.5%) transtemporal, 2 (1.7%) infratemporal, and 2 (1.7%) transcochlear. 85 patients received preoperative lumbar drains, 4 patients received intraoperative external ventricular drains (EVD), and 30 patients received no external source of CSF drainage. 1 patient had an already existing ventriculoperitoneal shunt and was excluded from evaluation. 11 patients (9.2%) suffered CSF leaks and 3 patients (2.5%) suffered surgical site infections. There was no statistically significant difference in the number of patients who suffered CSF leaks or surgical site infections when comparing those who received lumbar drains or EVDs to those who did not. 5 patients without lumbar drains (16.7%) and 13 (14.6%)with lumbar drains or EVDs demonstrated a CSF absorption disorder postoperatively either by CSF leak, pseudomeningocele, or hydrocephalus requiring a shunt. This incidence was not statistically significant between groups.

    Conclusions: In the recent BNI experience, lumbar drains and EVDs have not had an effect on the incidence of postoperative CSF leaks, pseudomeningoceles, shunting, or surgical site infections after posterior fossa craniotomies.

    Patient Care: If posterior fossa surgeries do not require lumbar drains to prevent CSF leaks and infection, neurosurgeons may be able to decrease patient discomfort as well as the time and cost of surgery by not placing lumbar drains.

    Learning Objectives: To identify the incidence of CSF leaks, pseudomeningoceles, shunting, or surgical site infections after posterior fossa craniotomies with and without lumbar drains.

    References: Bien AG, Bowdino B, Moore G, Leibrock L. Utilization of preoperative cerebrospinal fluid drain in skull base surgery. Skull Base. 2007 Mar;17(2):133-9. Cueva RA, Mastrodimos B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol. 2005 Nov;26(6):1176-81. Than KD, Baird CJ, Olivi A. Polyethylene glycol hydrogel dural sealant may reduce incisional cerebrospinal fluid leak after posterior fossa surgery. Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS182-6; discussion ONS186-7.

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