Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction: An Evidence-Based Approach to the Use of Lumbar Drains

Duc A Tien; Janalee K Stokken; Pablo F Recinos; Troy D Woodard; Raj Sindwani

doi:10.1016/j.otc.2015.09.007

Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction: An Evidence-Based Approach to the Use of Lumbar Drains

Otolaryngol Clin North Am. 2016 Feb;49(1):119-29. doi: 10.1016/j.otc.2015.09.007.

Authors

Duc A Tien¹, Janalee K Stokken², Pablo F Recinos³, Troy D Woodard³, Raj Sindwani⁴

Affiliations

¹ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.
² Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
³ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA.
⁴ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA. Electronic address: sindwar@ccf.org.

PMID: 26614832
DOI: 10.1016/j.otc.2015.09.007

Abstract

Before the vascularized pedicled nasoseptal flap was popularized, lumbar drains (LDs) were routinely used for cerebral spinal fluid (CSF) diversion in endoscopic skull base reconstruction. LDs are not necessary in most CSF leaks encountered during skull base surgery. In this article, the use is considered of an LD in select high-risk settings in which a high-flow leak is anticipated and the patient has significant risk factors that make closure of the leak more challenging. Evidence for the use of LDs in preventing postoperative after endoscopic skull base reconstruction is reviewed and a rational framework for their use is proposed.

Keywords: Cerebrospinal fluid diversion; Cerebrospinal fluid leak; Endoscopic skull base reconstruction; Lumbar drains; Minimally invasive skull base surgery; Subarachnoid drains.

Publication types

Review

MeSH terms

Cerebrospinal Fluid Leak / prevention & control*
Drainage / methods*
Endoscopy / adverse effects*
Humans
Lumbosacral Region
Neurosurgical Procedures / adverse effects*
Plastic Surgery Procedures / adverse effects*
Postoperative Complications / prevention & control*
Risk Factors
Skull Base / surgery
Skull Base Neoplasms / surgery