Perioperative lumbar drain utilization in transsphenoidal pituitary resection

Area of Science:

• Neurosurgery
• Endocrinology

Background:

• Transnasal resection of pituitary macroadenomas can lead to cerebrospinal fluid (CSF) leaks.
• Lumbar drains (LDs) are sometimes used to prevent or manage postoperative CSF leaks.

Purpose of the Study:

• To evaluate the efficacy of lumbar drains (LDs) in preventing postoperative CSF leaks after transnasal resection of pituitary macroadenomas.
• To assess the safety of LD insertion and its impact on hospital length of stay.

Main Methods:

• Retrospective review of 186 patients undergoing pituitary macroadenoma resection between 2006 and 2013.
• Patients were divided into two groups: Group 1 received a preoperative lumbar drain, while Group 2 did not.
• LDs were used for 48 hours, with removal if no leak was observed; treatment for existing leaks involved an LD trial.

Main Results:

• Postoperative CSF leak occurred in 1.9% of patients with an LD versus 5% without (p=0.3).
• Complication rates were similar between groups (13.7% vs 15.5%, p=0.72).
• Patients without LDs had a significantly shorter hospital stay (mean 2.7 days vs 4.7 days, p<0.001), often related to diabetes insipidus management.

Conclusions:

• Lumbar drain insertion is generally safe but does not significantly decrease CSF leak rates after pituitary macroadenoma resection.
• LD use is associated with an increased length of hospital stay.
• Minor complications like headaches and patient discomfort can occur with LD use.