title: Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence.
abstract: OBJECTIVE
  To determine if preoperative lumbar drain (LD) use reduces the incidence of postoperative cerebrospinal fluid (CSF) leak in patients undergoing acoustic neuroma resection.
  
  
  METHODS
  Retrospective review of 282 patients presenting for acoustic neuroma resection between 2005 and 2014.
  
  
  RESULTS
  Two hundred and eighty-two patients had a mean tumor size of 19.1 mm ± 10.2 mm. Twenty-nine (10.3%) patients developed a postoperative CSF leak. Two hundred and twenty patients (78.0%) received a preoperative LD, and 20 (9.1%) developed a CSF leak. Sixty-two (22.0%) patients did not receive a preoperative LD, and 9 (14.5%) developed a CSF leak. No significant difference in CSF leak frequency was observed with use versus no use of a LD (P = .23). Fifteen (5.3%) patients with an LD placed had a complication related to the LD. No significant difference in CSF leak frequency was observed with patient age, neurofibromatosis type-2 diagnosis, tumor size, or sidedness.
  
  
  CONCLUSIONS
  Postoperative CSF leaks are among the most common complications of acoustic neuroma microsurgery. No formal guidelines exist for elective placement of a preoperative LD to lower the incidence of CSF leaks. Our reported CSF leak incidence with preoperative LD placement is not significantly lower than without LD use, and there is a complication rate associated with LD use.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA matthew.crowson@dm.duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Crowson
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Calhoun D
authors.initials: CD
authors.lastname: Cunningham
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Moses
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Kaylie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology* / Q000517:prevention & control*; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: acoustic neuroma; cerebrospinal fluid leaks; clinical outcomes research; neurotology; otolaryngology; otology; outcome studies; vestibular schwannomas