|Title||Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index.|
|Publication Type||Journal Article|
|Year of Publication||2018|
|Authors||Cohen S, Jones SH, Dhandapani S, Negm HM, Anand VK, Schwartz TH|
|Journal||Oper Neurosurg (Hagerstown)|
|Date Published||2018 01 01|
|Keywords||Adult, 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|
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.
|Alternate Journal||Oper Neurosurg (Hagerstown)|