Perioperative lumbar drain placement: An independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery

• Published in: The Laryngoscope Vol. 121; no. 3; pp. 468 - 473
• Main Authors: Pepper, Jon-Paul, Lin, Erin M., Sullivan, Stephen E., Marentette, Lawrence J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-03-2011; Wiley-Blackwell
• Subjects: Adult; Biological and medical sciences; Brain Diseases - diagnosis; Brain Diseases - etiology; Cranial base; Cranial Fossa, Anterior - surgery; Drainage - adverse effects; Drainage - methods; Female; Humans; Level of Evidence: 2b; Male; Medical sciences; Middle Aged; Odds Ratio; Otorhinolaryngology. Stomatology; Perioperative Care - adverse effects; Perioperative Care - methods; Pneumocephalus - diagnosis; Pneumocephalus - etiology; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Skull Base Neoplasms - surgery; Spinal Puncture; Intracranial; Nervous system diseases; Lumbar spine; Anterior; ENT; Drain; Pneumocephalus; Cerebral disorder; Treatment; Surgery; Central nervous system disease; Complication; Predictive factor; Cranial base; Base of the skull
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.21409

Objective:
To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications.
Design:
Retrospective review of a series of patients (n = 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n = 45) underwent routine lumbar drain placement at the time of skull base surgery. The remainder of the series did not undergo routine perioperative lumbar drain placement.
Intervention:
Transglabellar/subcranial surgical approach to the anterior skull base, with or without routine perioperative lumbar drain placement.
Results:
Routine placement of perioperative lumbar drains was an independent predictor of tension pneumocephalus (P =.022, odds ratio = 11.22 [1.218–103.3]). In addition, this practice was also associated with an increased risk of intracranial complications overall (P =.025, odds ratio = 2.623 [1.104–6.233]).
Conclusion:
Routine placement of perioperative lumbar drain may be associated with an increased risk of tension pneumocephalus and intracranial complications during surgery of the anterior cranial base. Laryngoscope, 2011