title: Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction: An Evidence-Based Approach to the Use of Lumbar Drains.
abstract: Before the vascularized pedicled nasoseptal flap was popularized, lumbar drains (LDs) were routinely used for cerebral spinal fluid (CSF) diversion in endoscopic skull base reconstruction. LDs are not necessary in most CSF leaks encountered during skull base surgery. In this article, the use is considered of an LD in select high-risk settings in which a high-flow leak is anticipated and the patient has significant risk factors that make closure of the leak more challenging. Evidence for the use of LDs in preventing postoperative after endoscopic skull base reconstruction is reviewed and a rational framework for their use is proposed.
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.
authors.forename: Duc A
authors.initials: DA
authors.lastname: Tien
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
authors.forename: Janalee K
authors.initials: JK
authors.lastname: Stokken
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Recinos
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Woodard
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA. Electronic address: sindwar@ccf.org.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control*; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D008161:Lumbosacral Region; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery
keywords: Cerebrospinal fluid diversion; Cerebrospinal fluid leak; Endoscopic skull base reconstruction; Lumbar drains; Minimally invasive skull base surgery; Subarachnoid drains