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  • Title: Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery.
    Author: Allen KP, Isaacson B, Purcell P, Kutz JW, Roland PS.
    Journal: Otol Neurotol; 2011 Dec; 32(9):1522-4. PubMed ID: 21956598.
    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. 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.
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