J Neurol Surg B Skull Base 2016; 77 - LFP-13-03
DOI: 10.1055/s-0036-1592620

A Prospective, Randomized Control Trial for Lumbar Drain Placement after Endoscopic Endonasal Skull Base Surgery

Nathan T. Zwagerman 1, Samuel Shin 1, Eric W. Wang 2, Juan C. Fernandez-Miranda 1, Carl H. Snyderman 1, 2, Paul A. Gardner 1
  • 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • 2Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Objective: In this prospective, randomized control study, subjects who were at a high risk for postoperative cerebrospinal fluid (CSF) leak were randomized to receive either a postoperative lumbar drain or no drain to compare the rates of leak in the two groups.

Methods: The study was designed under IRB approval (PRO010030258) to randomize 186 consecutive patients who met at least one of the following criteria: (1) extensive arachnoid dissection, (2) dissection into a ventricle or cistern, or (3) dural defect greater than 1 cm2. These patients would next be randomized to either lumbar drainage for 72 hours or no drain.

Results: The trial was stopped early (170 patients) due to a significant difference in CSF leak between the drain and no drain groups. The most significant variable for postoperative leak was not having a drain (p < 0.011). During subgroup analysis, we found a significant (p < 0.021) difference between location of the tumor (anterior, posterior, suprasellar) and CSF leak rate. We also evaluated the size of the defects created in 108 patients and found that the average defect in the no leak group was 2.78 cm2 whereas the mean size of the defect in the leak group was 6.86 cm2. Although not significant, a clear trend was seen with a p < 0.076.

Conclusion: For patients undergoing endoscopic endonasal skull base surgery, prophylactic lumbar drain placement lowers the rate of postoperative CSF leak. The impact seems to be greatest in patients with large anterior or posterior cranial base defects.