Lumber drain morbidity in endonasal endoscopic skull base surgery

Jack L Birkenbeuel; Arash Abiri; Danielle C Warner; Emily Nguyen; Sylvana Marquina; Sanjita Gowda; Frank P K Hsu; Edward C Kuan

doi:10.1016/j.jocn.2022.04.026

Lumber drain morbidity in endonasal endoscopic skull base surgery

J Clin Neurosci. 2022 Jul:101:1-8. doi: 10.1016/j.jocn.2022.04.026. Epub 2022 Apr 28.

Authors

Jack L Birkenbeuel¹, Arash Abiri², Danielle C Warner³, Emily Nguyen⁴, Sylvana Marquina⁵, Sanjita Gowda⁶, Frank P K Hsu⁷, Edward C Kuan⁸

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: jbirkenb@uci.edu.
² Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: abiria@uci.edu.
³ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: Danielle.c.warner@kp.org.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: esnguyen@uci.edu.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: smarquin@uci.edu.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: gowdasp@uci.edu.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: fpkhsu@uci.edu.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA. Electronic address: eckuan@uci.edu.

PMID: 35490574
DOI: 10.1016/j.jocn.2022.04.026

Abstract

The purpose of this study is to describe the morbidity in patients undergoing endoscopic skull base surgery (ESBS) with and without intra-operative lumbar drain (LD) placement. A retrospective review of all patients undergoing ESBS from July 2018 to August 2020 at a tertiary academic skull base surgery program was conducted. Those with LD placement for aiding in suprasellar dissection and/or for CSF diversion following skull base repair were included. LD-related medical and technical complications were combined as composite outcomes to assess overall event rates in those with and without LD. 104 patients were included. Of the 104 participants, 64 (61.5%) had LD placed. Of these 64, 1 (0.96%) and 2 (1.9%) experienced postoperative medical (hypophysitis) and related technical (2 blood patches) complications, respectively. There was one case of postoperative CSF leak (in LD group) and no cases of DVT/PE or meningitis. LD use was not associated with increased risk of any complication (p = 0.165) compared to those without LD. There were no significant differences in rates of postoperative epistaxis (p = 0.427), readmission (p = 0.629), or reoperation (p = 0.165) between groups. Female sex was the only predictor of increased overall complication rates in patients with LD (OR, 1.122, 95% CI, 1.010-1.247, p = 0.032). Our findings suggest judicious use of a LD in endoscopic skull base surgery within a reasonable time does not increase the incidence of overall medical or technical complications, readmission, and reoperation.

Keywords: Endonasal; Endoscopic; Lumbar drain; Outcomes; Skull base surgery.

MeSH terms

Cerebrospinal Fluid Leak* / epidemiology
Cerebrospinal Fluid Leak* / etiology
Endoscopy / adverse effects
Female
Humans
Morbidity
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Retrospective Studies
Skull Base / surgery