Lumbar Drain Use during Middle Fossa Approaches for Nonneoplastic Pathology of the Skull Base

Robert J. Dambrino; Gunther W. Wong; Alan R. Tang; Jacob Jo; Aaron M. Yengo-Kahn; Nathan R. Lindquist; Michael H. Freeman; David S. Haynes; Kareem O. Tawfik; Lola B. Chambless; Reid C. Thompson; Peter J. Morone

doi:10.1055/a-2065-9178

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(03): 295-301
DOI: 10.1055/a-2065-9178

Original Article

Lumbar Drain Use during Middle Fossa Approaches for Nonneoplastic Pathology of the Skull Base

Robert J. Dambrino

¹Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Gunther W. Wong

²Vanderbilt University School of Medicine, Nashville, Tennessee, United States

,

Alan R. Tang

²Vanderbilt University School of Medicine, Nashville, Tennessee, United States

,

Jacob Jo

²Vanderbilt University School of Medicine, Nashville, Tennessee, United States

,

Aaron M. Yengo-Kahn

¹Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Nathan R. Lindquist

³Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Michael H. Freeman

³Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

David S. Haynes

³Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Kareem O. Tawfik

³Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Lola B. Chambless

¹Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Reid C. Thompson

¹Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

³Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States

,

Peter J. Morone

¹Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States

› Author Affiliations

Abstract

Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use.

Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation.

Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol (n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05–2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25–2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48–4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant (p = 0.07).

Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies.

Keywords

lumbar drain - superior semicircular canal dehiscence - encephalocele - cerebrospinal fluid leak

Full Text

References

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