title: Perioperative lumbar drain placement: an independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery.
abstract: OBJECTIVE
  To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications.
  
  
  METHODS
  Retrospective review of a series of patients (n = 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n = 45) underwent routine lumbar drain placement at the time of skull base surgery. The remainder of the series did not undergo routine perioperative lumbar drain placement.
  
  
  METHODS
  Transglabellar/subcranial surgical approach to the anterior skull base, with or without routine perioperative lumbar drain placement.
  
  
  RESULTS
  Routine placement of perioperative lumbar drains was an independent predictor of tension pneumocephalus (P =.022, odds ratio = 11.22 [1.218-103.3]). In addition, this practice was also associated with an increased risk of intracranial complications overall (P =.025, odds ratio = 2.623 [1.104-6.233]).
  
  
  CONCLUSIONS
  Routine placement of perioperative lumbar drain may be associated with an increased risk of tension pneumocephalus and intracranial complications during surgery of the anterior cranial base.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospital System, Alfred Taubman Health Care Center, Ann Arbor, Michigan, USA. jonpaul@umich.edu
authors.forename: Jon-Paul
authors.initials: JP
authors.lastname: Pepper
authors.forename: Erin M
authors.initials: EM
authors.lastname: Lin
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sullivan
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Marentette
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology*; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care / Q000009:adverse effects* / Q000379:methods; D011007:Pneumocephalus / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D019292:Skull Base Neoplasms / Q000601:surgery*; D013129:Spinal Puncture