Closed-suction drainage and cerebrospinal fluid leakage following microvascular decompression : a retrospective comparison study

Abstract

Objective: We performed this study to investigate whether the use of closed-suction drainage following microvascular decompression (MVD) causes cerebrospinal fluid (CSF) leakage.

Methods: Between 2004 and 2011, a total of 157 patients with neurovascular compression were treated with MVD. MVD was performed for hemifacial spasm in 150 (95.5%) cases and for trigeminal neuralgia in 7 (4.5%) cases. The mean age of the patients was 49.8±9.6 years (range, 20-69). Dural substitutes were used in 44 (28.0%) patients. Ninety-two patients (58.6%) were underwent a 4-5 cm craniotomy using drainage (drainage group), and 65 (41.4%) did a small 2-2.5 cm retromastoid craniectomy without closed-suction drainage (no-drainage group).

Results: Eleven (7.0%) patients experienced CSF leakage following MVD based on the criteria of this study; all of these patients were in the drainage group. In the unadjusted analyses, the incidence of CSF leakage was significantly related with the use of closed-suction drainage following MVD (12.0% in the drainage group vs. 0% in the no-drainage group, respectively; p=0.003; Fisher's exact test). Those who received dural substitutes and the elderly (cut-off value=60 years) exhibited a tendency to develop CSF leakage (p=0.075 and p=0.090, respectively; Fisher's exact test). In the multivariate analysis, only the use of closed-suction drainage was significantly and independently associated with the development of CSF leakage following MVD (odds ratio=9.900; 95% confidence interval, 1.418 to infinity; p=0.017).

Conclusion: The use of closed-suction drainage following MVD appears to be related to the development of CSF leakage.

Keywords: Cerebrospinal fluid leakage; Closed-suction drainage; Hemifacial spasm; Microvascular decompression; Trigeminal neuralgia.

Fig. 1

A 50-year-old male, whose drainage system drained air immediately following MVD, underwent an additional surgery on the 13th postoperative day for a cerebellar abscess combined with meningitis and middle ear effusion. A : A loop of the posterior inferior cerebellar artery (arrow) offending the root exit zone of the right facial nerve in the supra-olivary fossette. B : The immediate postoperative computed tomography scan shows the site of the surgery and a portion of the closed-suction drainage (arrow). C : A follow-up evaluation using temporal bone computed tomography for middle ear effusion and fever shows an opened mastoid air cell (arrow) and air density near the wound on the second postoperative day. Fluid in the mastoid air cells can also be identified. D : Follow-up magnetic resonance imaging on the sixth postoperative day shows abnormal lesions with contrast enhancement near the bone flap (arrow) and in the middle of the right cerebellar hemisphere (arrowhead). The mass effect is caused by the cerebellar abscess slightly displacing the pons to the left.