Abstract
Lumbar drains (LD) for cerebrospinal fluid (CSF) diversion are commonly used in pituitary surgery. CSF perioperative diversion can be utilized as a prophylactic measure and/or as a first line treatment for CSF rhinorrhea following transsphenoidal pituitary surgery. In theory, lumbar drainage can prevent and/or treat CSF leaks and may preclude reexploration surgery. We performed a literature review to study the value of LDs in decreasing the postoperative CSF leak rates in transsphenoidal surgery and the reported perioperative complications in relation to perioperative LD insertion. We included studies with more than 100 patients, in the period from 2000 to 2012. The overall incidence of postoperative CSF rhinorrhea was 1.7%. Out of 6,401 patients, 385 patients (6%) received LD to prevent postoperative CSF leak or as a therapeutic intervention. Complications with the use of LDs are not common; however, LDs can increase the length of hospitalization. The most common reported complications are headaches and patient discomfort. Major potential morbidities include additional surgery, meningitis, and tension pneumocephalus. Postoperative meningitis rate increases from 0.3% to 3% in cases with LD perioperative usage. The current literature does not provide conclusive evidence that lumbar drainage during pituitary surgery decreases postoperative CSF leaks; however, its use during pituitary surgery is safe and can beneficial in selected cases.
Highlights
Transsphenoidal pituitary surgery is a common surgical procedure that has been accepted as the standard approach to sellar lesions [1]
Lumbar drains (LD) for perioperative cerebrospinal fluid (CSF) diversion can be utilized as a prophylactic measure and/or as a first line treatment for CSF rhinorrhea following transsphenoidal pituitary surgery
We study the value of perioperative LD and review the current literature discussing LD usage methodology, CSF diversion indications, reported complication, and reported algorithms
Summary
Transsphenoidal pituitary surgery is a common surgical procedure that has been accepted as the standard approach to sellar lesions [1]. A national study, examining complications of transsphenoidal surgery, cites the incidence of postoperative CSF leak to be 3.9% [9]. With the introduction of the nasoseptal flap, the incidence of CSF leaks has significantly decreased after transsphenoidal surgery [10]. This procedure has reduced the incidence, it has not completely eliminated postoperative CSF leaks. Lumbar drains (LD) for perioperative CSF diversion can be utilized as a prophylactic measure and/or as a first line treatment for CSF rhinorrhea following transsphenoidal pituitary surgery. Lumbar drainage has been considered as a safe and effective treatment for CSF rhinorrhea following transsphenoidal surgery; this was not validated in prospective studies. We study the value of perioperative LD and review the current literature discussing LD usage methodology, CSF diversion indications, reported complication, and reported algorithms
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