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Neurological deterioration after lumbar cerebrospinal fluid drainage
P C Francel1, J A Persing, R W Cantrell
1Department of Neurological Surgery, Yale University School of Medicine, New Haven, CT 06510.
The Journal of Craniofacial Surgery
|November 1, 1992
Summary
Large-bore lumbar spinal fluid drainage for brain tumor surgery can cause serious complications, including coma. Intracranial drainage is a safer alternative to manage cerebrospinal fluid (CSF) during cranial base tumor resection.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Large-bore lumbar spinal fluid drainage is commonly employed in cranial base tumor resection.
- It aims to facilitate brain displacement, minimizing retraction-related damage.
Observation:
- Two patients experienced severe complications, including coma, following lumbar cerebrospinal fluid (CSF) drainage.
- Neurological status rapidly improved upon reinfusion of synthetic CSF solutions.
Findings:
- Lumbar drainage systems pose significant risks, including coma and potential persistent CSF leaks or nerve root injury.
- Intracranial CSF drainage offers a safer alternative by avoiding the risk of cerebral herniation.
Implications:
- Abandoning lumbar cistern drainage in favor of intracranial CSF drainage is recommended for managing CSF during cranial base tumor surgery.
- Alternative intracranial drainage sites include the cribriform plate, suprachiasmatic cistern, or sylvian fissure.
- Intracranial CSF drainage enhances patient safety by eliminating the risk of cerebral herniation associated with lumbar drainage.