|Title||Predictors and incidence of orthostatic headache associated with lumbar drain placement following endoscopic endonasal skull base surgery.|
|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Liang B, Shetty SR, Omay SBulent, Almeida JPaulo, Ni S, Chen Y-N, Ruiz-Treviño AS, Anand VK, Schwartz TH|
|Journal||Acta Neurochir (Wien)|
|Date Published||2017 08|
|Keywords||Adult, Aged, Drainage, Female, Headache, Humans, Incidence, Intracranial Hypotension, Male, Middle Aged, Neuroendoscopy, Postoperative Complications, Postoperative Period, Retrospective Studies, Risk Factors, Skull Base, Treatment Outcome|
BACKGROUND: Orthostatic headache (OH) is a potential complication of lumbar drainage (LD) usage. The incidence and risk factors for OH with the use of lumbar drainage during endoscopic endonasal procedures have not been documented.
OBJECTIVE: To investigate the incidence of post-procedure OHs associated with placement of LD in patients undergoing endoscopic endonasal procedures.
METHODS: We prospectively noted the placement of LDs in a consecutive series of endoscopic endonasal skull base surgeries. Charts were retrospectively reviewed, and patients were divided into two groups: those with OH and those without. The patient demographics, drain durations, imaging findings of intracranial hypotension, pathologies and need for a blood patch were compared between the two groups.
RESULTS: Two hundred forty-nine patients were included in the study. Seven patients (2.8%) suffered post-dural puncture OH, which was mild to moderate and disappeared 2-8 days (median 3 days) after treatment. Blood patches were used in four patients. Significant predisposing factors were age (33.0 vs. 53.5, P = 0.014) and a strong trend for female gender (85.7% vs. 47.9%, P = 0.062). BMI and drain duration were not significant. Postoperative intracranial hypotension was diagnosed radiographically in 43% of OH patients and in 5.4% of those without OH (P = 0.003). Four (1.6%) patients required treatment with an epidural blood patch.
CONCLUSION: OH associated with intracranial hypotension in patients undergoing endoscopic endonasal procedures with LDs is an infrequent complication seen more commonly in young female patients. Radiographic signs of intracranial hypotension are a specific but not sensitive test for OH.
|Alternate Journal||Acta Neurochir (Wien)|