Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Crowson, Matthew G.; Cunningham, Calhoun D.; Moses, Helen; Zomorodi, Ali R.; Kaylie, David M.

doi:10.1177/0003489415597917

Cited by 41 publications

(13 citation statements)

References 16 publications

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“…This strategy may not be beneficial for all patient populations. For example, a study of retromastoid surgery for acoustic neuroma found a 5% risk of lumbar drain complication with no significant difference in CSF leak rate [24]. In the current study, we found a clear benefit for the use of CSF diversion to treat hydrocephalus at the time of MMC closure in the prevention of wound complications.…”

Section: Discussionsupporting

confidence: 52%

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

et al. 2018

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Introduction: Myelomeningocele (MMC) is an open neural tube defect routinely surgically closed within 48 h of birth to prevent secondary infection. Up to 18% of patients experience wound complications, and 85% require shunting for hydrocephalus. We hypothesized that wound complications could be reduced by cerebrospinal fluid (CSF) diversion at the time of closure. Methods: Institutional review board approval was obtained to review records of the 88 patients who underwent MMC closure between January 2005 and June 2016 at the Children's Hospital of Pittsburgh. Twenty-three patients (26%) had an external ventricular drain (EVD) placed at the time of MMC closure and underwent 7-11 days of CSF drainage. Fourteen patients (16%) had a shunt placed at the time of MMC closure, and 51 (58%) had no form of CSF diversion at the time of MMC closure. Results: Patients with an EVD or shunt placed at the time of closure had no wound complications. In contrast, 8 patients (16%) without CSF diversion at closure developed wound complications (p = 0.048). Seven of the 8 wound complications occurred in the 71 patients with evidence of hydrocephalus at birth (p = 0.98). Of patients with evidence of hydrocephalus at the time of MMC closure, wound complications had a higher rate of occurrence among patients who did not receive a shunt or EVD at closure (p = 0.01). When comparing only patients with evidence of hydrocephalus at birth, the EVD group alone had a lower rate of wound complications than patients who did not receive CSF diversion at the time of closure (p = 0.031). Conclusions: These results suggest that addressing hydrocephalus at the time of MMC closure significantly reduces the likelihood of wound complications and may justify temporary CSF diversion at birth, at least in those patients manifesting hydrocephalus.

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Section: Discussionsupporting

confidence: 52%

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

et al. 2018

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“…In addition, it may be prudent to lend additional consideration to alternative therapeutic strategies such as observation or stereotactic radiosurgery in appropriate obese patients or to encourage weight loss prior to resection. Although pre-operative lumbar drain placement has not been shown to prevent post-operative CSF leak in lateral skull base surgery, 28 this is another option to consider. No association was detected between obesity and other complications, including wound infection, meningitis, thrombotic complications, or intracranial hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Association Between Body Mass Index and Complications in Acoustic Neuroma Surgery

Luryi

Babu

Michaelides

et al. 2020

Otolaryngol.--head neck surg.

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Objectives Elevated body mass index (BMI) is a risk factor for surgical complications, but data in acoustic neuroma surgery are conflicting and limited to small single-institution studies. This work evaluates associations between BMI and complications in surgery for acoustic neuroma (AN). Study Design Retrospective review. Setting: Two tertiary otology referral institutions. Subjects and Methods Patients undergoing surgery for AN. Univariate and multivariate analysis of association between BMI and complications was performed using two-tailed t tests and binary logistic regression. Results BMI ranged from 18.0 kg/m2 to 63.9 kg/m2 with mean of 29.2 kg/m2 among 362 included patients. High BMI was associated with increased risk of cerebrospinal fluid (CSF) leak ( p = 0.003) and need for revision surgery within 6 months ( p = 0.03). CSF leak occurred in 11.6% of obese patients (BMI ≥ 30.0) and 5.1% of patients with BMI < 30.0. There was no association between BMI and post-operative intracranial hemorrhage, wound infection, or incomplete resection ( p > 0.05). Multivariate analysis revealed BMI was associated with CSF leak (odds ratio 1.11 per BMI point, p = 0.002) and need for revision surgery (odds ratio 1.07 per BMI point, p = 0.02) independent of age, gender, tumor size, or surgical approach. Conclusions The largest series to date investigating BMI in acoustic surgery is presented. Elevated BMI is strongly associated with CSF leak and need for revision surgery but not with other complications. Obese or overweight patients undergoing acoustic neuroma resection should be counseled of their increased risk of CSF leak.

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“…Over- or under-drainage can cause headache [4, 6, 13-14, 16-17], pneumocephalus [13-14], vision loss [13], brainstem herniation [3, 8, 16], intracranial hemorrhage [5, 18], and death [13, 16]. Mechanical failures related to the catheter included insertion issues, blockage and breakage [3, 7], numbness or nerve root pain [3-5, 13], and other insertion site problems, such as pain or bleeding [2].…”

Section: Discussionmentioning

confidence: 99%

An Automated, Gravity-driven CSF Drainage System Decreases Complications and Lowers Costs

Lieberson

Eckermann

Meyer

et al. 2017

Cureus

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Background: FlowSafeTM (BeckerSmith Medical, Irvine, CA, USA) is a novel, robotic, external lumbar drainage (ELD) system, which was designed to control cerebrospinal fluid (CSF) drainage, reduce complications, and decrease treatment costs.Methods: Forty-seven consecutive neurosurgical patients requiring ELD were treated using the FlowSafe system.Results: In 39 of 40 patients with traumatic and surgical dural openings, potential CSF leaks were avoided. In seven patients with suspected normal pressure hydrocephalus, post-infectious ventriculomegaly, or pseudotumor cerebrum, we were able to assess the likelihood of improvement with shunting. The system, therefore, produced what we considered to be the “desired result” in 46 of 47 patients (98%). Our one treatment failure (2%) involved a patient with unrecognized hydrocephalus who, following a Chiari repair with a dural patch graft, was drained for six days. A persistent CSF leak eventually required a reoperation. Two patients (4%) described low-pressure headaches during treatment. Both responded to temporarily suspending or reducing the drainage rate. We saw no complications. Required nursing interventions were minimal. Conclusions: The FlowSafe system was safe and effective. In our experience, there were fewer complications compared to currently available ELD systems. The FlowSafe was well tolerated by our patients. The near elimination of nursing interventions should allow lumbar drainage to be delivered in less costly, non-intensive care unit settings. Larger trials will be needed.

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Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Cited by 41 publications

References 16 publications

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

Association Between Body Mass Index and Complications in Acoustic Neuroma Surgery

An Automated, Gravity-driven CSF Drainage System Decreases Complications and Lowers Costs

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