title: The utility of lumbar drains in modern endoscopic skull base surgery.
abstract: OBJECTIVE
  Lumbar drains were once routinely used for cerebrospinal fluid (CSF) diversion in endoscopic skull base reconstruction. The vascularized pedicled nasoseptal flap has now become the reconstructive workhorse in the setting of high-flow leaks. High-flow CSF leaks occur when there is violation of a cistern or ventricle. As lumbar drains have the potential for significant complications and the rate of postoperative CSF leak has decreased with the use of vascularized flaps, lumbar drain use has been challenged.
  
  
  RESULTS
  Lumbar drains have a reported 3% major and 5% minor complication rates. Two recent studies reviewed their postoperative CSF leak rates after reconstruction of high-flow leaks. Garcia-Navarro described 46 cases in which a lumbar drain was placed in 67% of patients with two postoperative CSF leaks, one in each group. Eloy et al. described 59 patients without lumbar drain and reported no postoperative CSF leaks.
  
  
  CONCLUSIONS
  Lumbar drains are not necessary in the settings of low-flow CSF leaks or even in all high-flow leaks. We consider the use of a lumbar drain in settings wherein a high-flow leak is encountered or anticipated and the patient has other risk factors that may make the risk of postoperative CSF leak higher or closure of the leak more difficult.
authors.affiliation: aSection of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute bNeurosurgical Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Janalee
authors.initials: J
authors.lastname: Stokken
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Recinos
authors.forename: Troy
authors.initials: T
authors.lastname: Woodard
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D002555:Cerebrospinal Fluid; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D008159:Lumbar Vertebrae; D019291:Skull Base / Q000601:surgery*