title: The benefit of early lumbar drain insertion in reducing the length of CSF leak in traumatic rhinorrhea.
abstract: OBJECTIVE
  In traumatic CSF leaks, the early lumbar drain (LD) placement could significantly shorten the rhinorrhea period.
  
  
  METHODS
  Included were patients presenting CSF rhinorrhea subsequent to closed head trauma, admitted within 24h. Patients were randomly allocated into two treatment arms: 30 patients within Group A with CSF diversion via LD and 30 patients in Group B managed conservatively with bed rest and head elevation. Primary outcome was length of CSF rhinorrhea. Secondary outcomes were recurrent CSF leaks and meningitis occurrence.
  
  
  RESULTS
  In Group A leak stopped within 10 days, in Group B leak persisted beyond 10 days in 2 patients. In Group A CSF leak time was 4.83±1.88 days while in Group B was 7.03±2.02 days. The difference is statistically significant: 2.2 days (95% CI 3.05-1.35), p<0.0001. During follow-up recurrent CSF leak developed in 7 patients (23%) in Group A and in 8 patients (27%) in Group B (p=0.63, not significant). Meningitis occurred in 3 patients in Group A (10%) and in 4 cases in Group B (13%) (p=0.61, not significant).
  
  
  CONCLUSIONS
  The initial use of LDs in highly selected patients with traumatic CSF rhinorrhea resulted in a significant decrease of leakage. Nevertheless, the benefits should be carefully weighted with drawbacks.
authors.affiliation: Second Department of Otolaryngology, Romania. Electronic address: silviualbu63@gmail.com.
authors.forename: Silviu
authors.initials: S
authors.lastname: Albu
authors.affiliation: Department of Neurosurgery, Romania.
authors.forename: Ioan S
authors.initials: IS
authors.lastname: Florian
authors.affiliation: Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
authors.forename: Sorana D
authors.initials: SD
authors.lastname: Bolboaca
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008581:Meningitis / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: CSF rhinorrhea; Conservative management; Lumbar drain; Outcomes