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Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index.

TitleLumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index.
Publication TypeJournal Article
Year of Publication2018
AuthorsCohen S, Jones SH, Dhandapani S, Negm HM, Anand VK, Schwartz TH
JournalOper Neurosurg (Hagerstown)
Volume14
Issue1
Pagination66-71
Date Published2018 01 01
ISSN2332-4260
KeywordsAdult, Aged, Aged, 80 and over, Body Mass Index, Cerebrospinal Fluid Leak, Drainage, Female, Humans, Male, Meningeal Neoplasms, Meningioma, Middle Aged, Obesity, Postoperative Complications, Risk Factors, Transanal Endoscopic Surgery, Treatment Outcome
Abstract

BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak is a persistent, albeit much less prominent, complication following endonasal endoscopic surgery. The pathology with highest risk is suprasellar meningiomas. A postoperative lumbar drain (LD) is used to decrease the risk of CSF leak but is not universally accepted.

OBJECTIVE: To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas.

METHODS: A consecutive series of newly diagnosed suprasellar meningiomas was drawn from a prospectively acquired database of endonasal endoscopic surgeries at our institution. An intraoperative, preresection LD was placed and left open at 5 cc/h for ∼48 h. In a subset of patients, the LD could not be placed. Rates of postoperative CSF leak were compared between patients with and without an LD.

RESULTS: Twenty-five patients underwent endonasal endoscopic surgical resection of suprasellar meningiomas. An LD could not be placed in 2 patients. There were 2 postoperative CSF leaks (8%), both of which occurred in the patients who did not have an LD (P = .0033). The average body mass index (BMI) of the patients in whom the LD could not be placed was 39.1 kg/m2, compared with 27.6 kg/m2 for those in whom the LD could be placed (P = .009). In the subgroup of obese patients (BMI > 30 kg/m2), LD placement was protective against postoperative CSF leak (P = .022).

CONCLUSION: The inability to place an LD in patients with obesity is a risk factor for postoperative CSF leak. An LD may be useful to prevent postoperative CSF leak, particularly in patients with elevated BMI.

DOI10.1093/ons/opx070
Alternate JournalOper Neurosurg (Hagerstown)
PubMed ID29253284