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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: 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%).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

Immediate postoperative, noncontrasted computed tomography (CT) head with scant pneumocephalus and trace extra-axial hemorrhage (A). Left greater than right frontal hypodensity, representing persistent edema, continued mass effect, and reduced subfalcine herniation. Postoperative day 1, noncontrasted CT head with persistent bifrontal edema, worsened mass effect on the left lateral ventricle (B). Postoperative, noncontrasted CT head status postbifrontal decompressive craniectomy (C). Evidence of extensive cerebral edema, effacement of the sulcal-gyral pattern with loss of gray-white differentiation. Slit-like ventricles. Crowding of the basilar cisterns. Herniation through the craniectomy site.
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FI120026-3: Immediate postoperative, noncontrasted computed tomography (CT) head with scant pneumocephalus and trace extra-axial hemorrhage (A). Left greater than right frontal hypodensity, representing persistent edema, continued mass effect, and reduced subfalcine herniation. Postoperative day 1, noncontrasted CT head with persistent bifrontal edema, worsened mass effect on the left lateral ventricle (B). Postoperative, noncontrasted CT head status postbifrontal decompressive craniectomy (C). Evidence of extensive cerebral edema, effacement of the sulcal-gyral pattern with loss of gray-white differentiation. Slit-like ventricles. Crowding of the basilar cisterns. Herniation through the craniectomy site.

Mentions: During the subfrontal/interhemispheric approach, the left frontal lobe was noted to be edematous and swollen. An additional 25 g of IV mannitol was given and another 10 cc of CSF drained via the LD. Near-total surgical resection was achieved and a small portion of the tumor encasing the left anterior cerebral artery was left intentionally. Following surgery, the patient was extubated without incident and had a normal neurological examination. A postoperative cranial CT obtained within 6 hours of surgery showed an appropriate resection cavity without evidence of hemorrhage or ventricular dilatation. Mild pneumocephalus without tension was noted (Fig. 3). In the neurosurgical ICU, the LD was leveled at the shoulder and set to drain 10cc/hr. Tumor pathology was consistent with a World Health Organization (WHO) II atypical meningioma with a Ki-67 proliferation index of 4% that was progesterone receptor positive and featured prominent nucleoli and several foci of necrosis.


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)

Immediate postoperative, noncontrasted computed tomography (CT) head with scant pneumocephalus and trace extra-axial hemorrhage (A). Left greater than right frontal hypodensity, representing persistent edema, continued mass effect, and reduced subfalcine herniation. Postoperative day 1, noncontrasted CT head with persistent bifrontal edema, worsened mass effect on the left lateral ventricle (B). Postoperative, noncontrasted CT head status postbifrontal decompressive craniectomy (C). Evidence of extensive cerebral edema, effacement of the sulcal-gyral pattern with loss of gray-white differentiation. Slit-like ventricles. Crowding of the basilar cisterns. Herniation through the craniectomy site.
© Copyright Policy
Related In: Results  -  Collection

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

FI120026-3: Immediate postoperative, noncontrasted computed tomography (CT) head with scant pneumocephalus and trace extra-axial hemorrhage (A). Left greater than right frontal hypodensity, representing persistent edema, continued mass effect, and reduced subfalcine herniation. Postoperative day 1, noncontrasted CT head with persistent bifrontal edema, worsened mass effect on the left lateral ventricle (B). Postoperative, noncontrasted CT head status postbifrontal decompressive craniectomy (C). Evidence of extensive cerebral edema, effacement of the sulcal-gyral pattern with loss of gray-white differentiation. Slit-like ventricles. Crowding of the basilar cisterns. Herniation through the craniectomy site.
Mentions: During the subfrontal/interhemispheric approach, the left frontal lobe was noted to be edematous and swollen. An additional 25 g of IV mannitol was given and another 10 cc of CSF drained via the LD. Near-total surgical resection was achieved and a small portion of the tumor encasing the left anterior cerebral artery was left intentionally. Following surgery, the patient was extubated without incident and had a normal neurological examination. A postoperative cranial CT obtained within 6 hours of surgery showed an appropriate resection cavity without evidence of hemorrhage or ventricular dilatation. Mild pneumocephalus without tension was noted (Fig. 3). In the neurosurgical ICU, the LD was leveled at the shoulder and set to drain 10cc/hr. Tumor pathology was consistent with a World Health Organization (WHO) II atypical meningioma with a Ki-67 proliferation index of 4% that was progesterone receptor positive and featured prominent nucleoli and several foci of necrosis.

Bottom Line: 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%).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