Neurological deterioration after lumbar cerebrospinal fluid drainage.
Large-bore lumbar spinal fluid drainage is used frequently as part of the preoperative and intraoperative management of patients undergoing cranial base tumor resection. Such drainage allows displacement of the brain with minimal force, thereby potentially decreasing retraction damage to it. We document 2 patients in whom serious complications resulted from lumbar drainage systems. These patients deteriorated into a coma state following cerebrospinal fluid (CSF) drainage. Reinfusion of synthetic CSF solutions caused a brisk return to normal neurological status. These plus other potential complications associated with lumbar drainage, such as persistent CSF leaks into the back and soft-tissue nerve root injury, warranted abandoning the lumbar cistern drainage route of CSF drainage in favor of drainage directly from the intracranial compartment. Depending on the particular operation performed, drainage of CSF near the cribriform plate, the suprachiasmatic cistern, or from the sylvian fissure may be effective sites for CSF drainage. Unlike lumbar drainage, intracranial CSF drainage does not have the added risk of promoting cerebral herniation.
Francel
P C
PC
Department of Neurological Surgery, Yale University School of Medicine, New Haven, CT 06510.
Persing
J A
JA
Cantrell
R W
RW
Levine
P A
PA
Newman
S A
SA
D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects; D004388:Dura Mater / Q000601:surgery*; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D018241:Neuroectodermal Tumors, Primitive, Peripheral / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000601:surgery; D012888:Skull Neoplasms / Q000601:surgery*; D013129:Spinal Puncture / Q000009:adverse effects*