Lumber drain morbidity in endonasal endoscopic skull base surgery

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Endoscopic skull base surgery (ESBS) offers minimally invasive approaches.
• Intraoperative lumbar drain (LD) placement is utilized for specific surgical needs, such as suprasellar dissection and cerebrospinal fluid (CSF) diversion.
• The safety and impact of LD use on patient morbidity in ESBS require further clarification.

Purpose of the Study:

• To evaluate and compare the morbidity associated with endoscopic skull base surgery (ESBS) in patients who underwent the procedure with and without intraoperative lumbar drain (LD) placement.
• To assess the incidence of medical and technical complications related to LD use during ESBS.

Main Methods:

• Retrospective review of 104 patients undergoing ESBS between July 2018 and August 2020.
• Patients were categorized into those with and without intraoperative LD placement.
• Composite outcomes combined LD-related medical and technical complications to determine event rates.

Main Results:

• 64% of patients had LD placed; 1.9% experienced minor medical or technical complications.
• No significant difference in overall complication rates between LD and no-LD groups (p=0.165).
• No significant differences in postoperative epistaxis, readmission, or reoperation rates were observed between groups.

Conclusions:

• Judicious use of intraoperative lumbar drains in endoscopic skull base surgery does not increase the overall incidence of medical or technical complications.
• LD placement is not associated with increased rates of readmission or reoperation in ESBS.
• Female sex was identified as a predictor of increased overall complication rates in patients with LD (OR, 1.122).