What Is the Evidence for Postoperative Lumbar Drains in Endoscopic Repair of CSF Leaks?

by Joshua Bakhsheshian, MS, Michelle S. Hwang, BS, and Michael Friedman, MD •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

Background

The overall success rate for endonasal endoscopic repair of cerebrospinal spinal fluid (CSF) leaks is high, ranging from 90% for primary repairs to 97% for secondary. With the advancement of vascularized flaps, the rates of postoperative reoccurrence of CSF leaks have decreased. The complication rate is reportedly less than 0.03%; however, when they occur, they can include CSF leak reoccurrence and bacterial meningitis. The role of postoperative lumbar drains (LD) in the endoscopic management of CSF rhinorrhea is currently controversial. Cerebrospinal spinal fluid diversion with a lumbar drain may prevent postoperative intracranial pressure (ICP) elevations that would disrupt the graft closure. However, LD utilization has been associated with increased complication rates of up to 12.3%. These complications include pneumocephalus, persistent headaches, meningitis, uncal herniation, and lumbar radiculopathy.

Best Practice

There is a high level of evidence demonstrating that lumbar drains do not reduce postoperative CSF leaks. Future multicenter RCTs designed to investigate the use of lumbar drains in higher risk repairs are needed (Laryngoscope. 2015;125:2245-2246).