title: Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery.
abstract: OBJECTIVE
  To determine the efficacy of lumbar drainage in managing cerebrospinal fluid (CSF) leak after lateral skull base surgery.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Patients who had a lumbar subarachnoid drain placed after a lateral skull base procedure between July 1999 and February 2010 were included.
  
  
  METHODS
  Patients were identified by searching medical records for lateral skull base approach Current Procedural Terminology codes. The following variables were recorded for each subject: diagnosis, type of lateral skull base operation, duration of lumbar drainage, need for revision surgery, and presence of meningitis.
  
  
  METHODS
  Successful cessation of postoperative CSF leakage.
  
  
  RESULTS
  Five hundred eight charts were reviewed, and 63 patients were identified who received a lumbar drain after a lateral skull base operation. The most common diagnosis was acoustic neuroma in 61.9%. The most common skull base approaches were the translabyrinthine, middle fossa, and transpetrosal approaches. Approximately 60.3% of patients had CSF rhinorrhea, 23.8% had an incisional leak, and 14.3% had otorrhea. The mean duration of lumbar drainage was 4.6 days. Forty eight (76.2%) study subjects had resolution of their CSF leak with lumbar drainage. Fifteen patients (23.8%) required revision surgery to stop the CSF leak. Lumbar drainage was successful in 90% of leaks after the translabyrinthine approach but in only 50% of those undergoing a suboccipital approach, which was a statistically significant difference.
  
  
  CONCLUSIONS
  Postoperative CSF leaks after lateral skull base surgery can be managed with a lumbar subarachnoid drain in a majority of cases but is more successful after the translabyrinthine than the suboccipital approach. Recurrent CSF leaks after lumbar drainage is likely to require a revision operation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Allen
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
authors.forename: Patricia
authors.initials: P
authors.lastname: Purcell
authors.forename: Joe Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D009464:Neuroma, Acoustic / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome