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) |
Volume | 159 |
Issue | 8 |
Pagination | 1379-1385 |
Date Published | 2017 08 |
ISSN | 0942-0940 |
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 |
Abstract | 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. |
DOI | 10.1007/s00701-017-3247-4 |
Alternate Journal | Acta Neurochir (Wien) |
PubMed ID | 28643170 |