Newswise — Winner of the Synthes Skull Base Award, Nathan T. Zwagerman, MD, presented his research, A Prospective, Randomized Control Trial for Lumbar Drain Placement after Endoscopic Endonasal Skull Base Surgery, during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Cerebrospinal fluid (CSF) leaks remain a complication after endoscopic endonasal surgery. In this study, subjects were randomized to receive an immediate postoperative lumbar drain or not, with comparison of postoperative leak rates.
The study randomized patients to lumbar drainage or no drain following reconstruction. The inclusion criteria included: 1) extensive arachnoid dissection, 2) dissection into a ventricle or cistern and 3) dural defect greater than 1cm. Demographic data, tumor location, defect size and leak rates were collected. The study was approved by the Institutional Review Board.
The trial was stopped early (170 patients) due to a significant difference in CSF leak rate between the experimental (drain) and control (no drain) groups (p=<0.002). No significant differences were found in the demographic measures between the two groups with an average age of 51.2 years (19–86) and BMI of 31.1. The most significant variable for postoperative leak was not having a drain. A difference in leak rate was found based upon the tumor location (anterior, posterior, suprasellar); however, this difference was not significant when a drain was employed. Defect size was noted to be larger in the group with leaks compared to the control group. 36 patients had anterior pathology (olfactory groove or planum), and their leak rate was 10 percent with and 35 percent without a drain (p=0.04). 50 patients had posterior pathology (clival) with a leak rate of 13 percent with and 30 percent without a drain (p=0.025). Finally, 85 patients had suprasellar lesions and their leak rate was 4.7 percent with and 9.5 percent without a drain (p=0.68).
For patients undergoing endoscopic endonasal skull base surgery, 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.
Author Block: Nathan T. Zwagerman, MD; Samuel Shin; Georgios Zenonos; Eric Wang; Juan Fernandez-Miranda; Carl Snyderman; Paul Gardner (Pittsburgh)
Disclosure: The author reported no conflicts of interest.
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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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