Intermittent Lumbar Drainage as a Viable Treatment Option for Cerebrospinal Fluid Rhinorrhea Complicating Pituitary Surgery

Abstract

Cerebrospinal fluid (CSF) rhinorrhea is a known complication of pituitary surgery. CSF diversion, either by continuous lumbar drainage or by serial lumbar punctures, is one of its treatment methods. But complications like over-drainage syndromes and infections are reported with continuous drainage and serial punctures can be uncomfortable for the patient. To avoid these problems, we drained CSF intermittently via indwelling subarachnoid catheters in 11 patients who had developed CSF rhinorrhea after pituitary surgery. CSF was aspirated twice daily via an epidural catheter placed in the subarachnoid space. Each time approximately 30-40 ml of CSF was aspirated over 15-20 minutes. The technique was successful in 10 out of 11 patients treated (91%). CSF leaks stopped within 2-4 days of drainage and the total duration of catheterization was 4-6 days. In 2 patients, blockage of catheter required reinsertion. No patient developed complications of over-drainage or meningitis. Intermittent lumbar drainage is a feasible non-operative alternative to re-operation and dural repair for the treatment of CSF rhinorrhea. The risk of developing serious side effects seen with continuous drainage may be avoided with this method and it requires only minimal support staff for management.