Efficacy of Perioperative Lumbar Drainage following Endonasal Endoscopic Cerebrospinal Fluid Leak Repair.
Objective Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well-established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta-analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea. Data Sources A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015). Review Method A meta-analysis was performed according to PRISMA guidelines. Results A total of 1314 nonduplicate studies were identified in our search. Twelve articles comprising 508 cases met inclusion criteria. Overall, use of LDs was not associated with significantly lower postoperative CSF leak recurrence rates following endoscopic repair of CSF rhinorrhea (odds ratio: 0.89, 95% confidence interval: 0.40-1.95) as compared with cases performed without LDs. Subgroup analysis of only CSF leaks associated with anterior skull base resections (6 studies, 153 cases) also demonstrated that lumbar drainage did not significantly affect rates of successful repair (odds ratio: 2.67, 95% confidence interval: 0.64-11.10). Conclusions There is insufficient evidence to support that adjunctive lumbar drainage significantly reduces postoperative CSF leak recurrence in patients undergoing endoscopic CSF leak repair. Subgroup analysis examining only those patients whose CSF leaks were associated with anterior skull base resections demonstrated similar results. More level 1 and 2 studies are needed to further investigate the efficacy of LDs, particularly in the setting of patients at high risk for CSF leak recurrence.
1 Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA.
Omar H
OH
Ahmed
1 Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA.
Sonya
S
Marcus
2 School of Medicine, New York University, New York, New York, USA.
Jenna R
JR
Tauber
3 Department of Population Health, Division of Biostatistics, New York University, New York, New York, USA.
Binhuan
B
Wang
4 Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, New Jersey, USA.
Yixin
Y
Fang
1 Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA.
Richard A
RA
Lebowitz
D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D004322:Drainage; D004724:Endoscopy; D006801:Humans; D019990:Perioperative Care; D012008:Recurrence; D016896:Treatment Outcome
cerebrospinal fluid diversion; cerebrospinal fluid leak; cerebrospinal fluid rhinorrhea; endoscopic skull base surgery; lumbar drains