Lumbar Subarachnoid Drainage in Cerebrospinal Fluid Leaks After Lateral Skull Base Surgery

作者：Allen Kyle P; Isaacson Brandon^*; Purcell Patricia; Kutz Joe Walter Jr; Roland Peter S

来源：Otology & Neurotology, 2011, 32(9): 1522-1524.

DOI：10.1097/MAO.0b013e318232e387

• Cerebrospinal fluid leak
• Skull base surgery
• Lumbar subarachnoid drain
• Translabyrinthine approach
• Acoustic neuroma

Objective: To determine the efficacy of lumbar drainage in managing cerebrospinal fluid (CSF) leak after lateral skull base surgery.
Study Design: Retrospective case review.
Setting: 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.

• 出版日期2011-12