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The efficacy and safety of preoperative lumbar drain placement in anterior skull base surgery.

Ackerman PD, Spencer DA, Prabhu VC - J Neurol Surg Rep (2013)

Bottom Line: No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20).Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail.Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States.

ABSTRACT
This study assesses the efficacy of preoperative lumbar drain (LD) placement prior to elective open cranial and endoscopic anterior skull base (ASB) surgery in reducing postoperative cerebrospinal fluid (CSF) leak. A retrospective review of 93 patients who underwent LD placement at our institution between 2006 and 2011 was performed. Of these patients, 43 underwent elective LD placement prior to ASB surgery; 2 patients had evidence of CSF rhinorrhea prior to surgery, and 41 had no evidence of a preoperative CSF leak. Of those 41 patients, 2 developed CSF rhinorrhea (2/41= 4.9%) as a result of surgery-all in our endoscopic patient population (N = 21; 2/21= 9.5%). No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20). Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail. Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement.

No MeSH data available.


Related in: MedlinePlus

Preoperative T1-weighted, gadolinium-enhanced axial and sagittal images (top) demonstrating an isointense, poorly enhancing sellar mass with suprasellar extension causing mass effect on the optic chiasm (A). Postoperative noncontrast computed tomography (CT) head with minimal pneumocephalus noted in the resection cavity and adjacent to the bilateral frontal lobes. No intracranial hemorrhage or evidence of edema (B).
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FI120026-1: Preoperative T1-weighted, gadolinium-enhanced axial and sagittal images (top) demonstrating an isointense, poorly enhancing sellar mass with suprasellar extension causing mass effect on the optic chiasm (A). Postoperative noncontrast computed tomography (CT) head with minimal pneumocephalus noted in the resection cavity and adjacent to the bilateral frontal lobes. No intracranial hemorrhage or evidence of edema (B).

Mentions: This 73-year-old Caucasian woman with a history of diabetes mellitus, hypertension, and significant cardiac disease (for which she had previously undergone coronary artery bypass surgery) presented with headaches and blurry vision in her left eye. A bitemporal hemianopsia was noted on formal visual field testing. Magnetic resonance imaging (MRI) revealed a homogenously enhancing, sellar lesion with suprasellar extension and compression of the optic chiasm (Fig. 1). She had a LD placed prior to undergoing an uncomplicated endoscopic, transnasal, transsphenoidal resection of a benign pituitary adenoma with suprasellar extension and invasion of the floor of the third ventricle. At the conclusion of the case, the patient had a sellar floor reconstruction with abdominal fat bolstered by Gelfoam covered by DuraSeal with nasal packing. Postoperatively, the patient remained flat with the LD set at shoulder level set to drain 10 to 15 cc/hr. Postoperative cranial computed tomography (CT) revealed minimal intracranial air and no evidence of hemorrhage (Fig. 1). Postoperative polyuria and transient hypernatremia (peak Na 147 mmol/L) required one dose of desmopressin (DDAVP; Sanofi-aventis, Bridgewater, New Jersey, USA). Approximately 300 cc of CSF was drained via the LD over 2 days, the nasal packing was removed, and the LD was clamped and then removed on the fourth postoperative day with no evidence of a CSF leak.


The efficacy and safety of preoperative lumbar drain placement in anterior skull base surgery.

Ackerman PD, Spencer DA, Prabhu VC - J Neurol Surg Rep (2013)

Preoperative T1-weighted, gadolinium-enhanced axial and sagittal images (top) demonstrating an isointense, poorly enhancing sellar mass with suprasellar extension causing mass effect on the optic chiasm (A). Postoperative noncontrast computed tomography (CT) head with minimal pneumocephalus noted in the resection cavity and adjacent to the bilateral frontal lobes. No intracranial hemorrhage or evidence of edema (B).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713560&req=5

FI120026-1: Preoperative T1-weighted, gadolinium-enhanced axial and sagittal images (top) demonstrating an isointense, poorly enhancing sellar mass with suprasellar extension causing mass effect on the optic chiasm (A). Postoperative noncontrast computed tomography (CT) head with minimal pneumocephalus noted in the resection cavity and adjacent to the bilateral frontal lobes. No intracranial hemorrhage or evidence of edema (B).
Mentions: This 73-year-old Caucasian woman with a history of diabetes mellitus, hypertension, and significant cardiac disease (for which she had previously undergone coronary artery bypass surgery) presented with headaches and blurry vision in her left eye. A bitemporal hemianopsia was noted on formal visual field testing. Magnetic resonance imaging (MRI) revealed a homogenously enhancing, sellar lesion with suprasellar extension and compression of the optic chiasm (Fig. 1). She had a LD placed prior to undergoing an uncomplicated endoscopic, transnasal, transsphenoidal resection of a benign pituitary adenoma with suprasellar extension and invasion of the floor of the third ventricle. At the conclusion of the case, the patient had a sellar floor reconstruction with abdominal fat bolstered by Gelfoam covered by DuraSeal with nasal packing. Postoperatively, the patient remained flat with the LD set at shoulder level set to drain 10 to 15 cc/hr. Postoperative cranial computed tomography (CT) revealed minimal intracranial air and no evidence of hemorrhage (Fig. 1). Postoperative polyuria and transient hypernatremia (peak Na 147 mmol/L) required one dose of desmopressin (DDAVP; Sanofi-aventis, Bridgewater, New Jersey, USA). Approximately 300 cc of CSF was drained via the LD over 2 days, the nasal packing was removed, and the LD was clamped and then removed on the fourth postoperative day with no evidence of a CSF leak.

Bottom Line: No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20).Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail.Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States.

ABSTRACT
This study assesses the efficacy of preoperative lumbar drain (LD) placement prior to elective open cranial and endoscopic anterior skull base (ASB) surgery in reducing postoperative cerebrospinal fluid (CSF) leak. A retrospective review of 93 patients who underwent LD placement at our institution between 2006 and 2011 was performed. Of these patients, 43 underwent elective LD placement prior to ASB surgery; 2 patients had evidence of CSF rhinorrhea prior to surgery, and 41 had no evidence of a preoperative CSF leak. Of those 41 patients, 2 developed CSF rhinorrhea (2/41= 4.9%) as a result of surgery-all in our endoscopic patient population (N = 21; 2/21= 9.5%). No postoperative CSF leaks were noted in our open ASB surgery cohort (N = 20). Other complications were rare, but we encountered two instances of delayed malignant cerebral edema in the open ASB cohort that are discussed in detail. Overall, preoperative LD placement was found to be an effective means of preventing postoperative CSF leaks after ASB approaches, but potential and significant intracranial complications may occur in select patients that merit careful consideration prior to LD placement.

No MeSH data available.


Related in: MedlinePlus