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. 2007 Mar;17(2):133-9.
doi: 10.1055/s-2007-970562.

Utilization of preoperative cerebrospinal fluid drain in skull base surgery

Alexander G Bien  1 , Bradley Bowdino, Gary Moore, Lyal Leibrock
Affiliations

Utilization of preoperative cerebrospinal fluid drain in skull base surgery

Alexander G Bien et al. Skull Base. 2007 Mar.

Abstract

Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula.

Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension.

Results: Between 1989 and 1994, 25/72 (35%) patients with no preoperative lumbar drain had a postoperative CSF leak. From 1995 to 2000, 9/78 (12%) patients with a preoperative lumbar drain had a CSF leak. This was a 23% decreased incidence of postoperative CSF leakage and a significant decrease in the probability (p < 0.001) of CSF leakage in patients treated with a preoperative lumbar drain. The comorbidities of diabetes, smoking, or hypertension did not increase the probability of a CSF leak (p = 0.43).

Conclusions: A preoperatively placed lumbar drain can significantly lower the rate of postoperative CSF leakage after skull base surgery. The drain is a well-tolerated adjunct to dural closure and helps increase surgical exposure of the posterior fossa. The comorbidities of diabetes, smoking, or hypertension do not contribute to an increased rate of CSF leakage.dagger Lyal Leibrock M.D., F.A.C.S. is Deceased.

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Figures

Figure 1
Figure 1
(A) Titanium mesh covering dural defect. (B) Hydroxyapatite paste applied over titanium mesh to complete cranioplasty.
Figure 2
Figure 2
Comparison of CSF leak with and without drain.
See this image and copyright information in PMC

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