Safety Profile of Select Perioperative Lumbar Drain Use After Endoscopic Endonasal Surgery

Lumbar drains (LD) may be selectively used in complex endoscopic endonasal surgery (EES) to promote cerebrospinal fluid (CSF) diversion and decrease CSF leak rates. Perioperative outcomes related to LD insertion have not been described in detail. We aimed to study safety profiles and complications associated with LD placement for EES.

We retrospectively reviewed patients undergoing EES for anterior skull-base tumors from January 2014 to December 2023. Patients were stratified based on selected use or nonuse of a LD placed perioperatively. Drain-related complications and outcomes were determined for LD patients.

Of 690 patients, 141 (20.4%) underwent LD insertion at the time of EES. Most LD patients (81.6%) underwent an extended EES compared with 14.4% of non-LD patients. Common pathologies for LD patients included pituitary adenoma (27.7%), craniopharyngioma (21.3%), meningioma (9.9%), and chordoma (5.7%). Tumor invasion into parasellar regions, including the suprasellar, infrasellar, and cavernous sinus spaces, was common (97.4%). The median drain duration was 4 days (range: 0-18 days). The average amount of CSF diverted was 650 mL (SD = 318 mL). Rates of postoperative CSF leak and meningitis in this select high-risk group were 16.3% and 3.6%, respectively. There was no significant difference among the LD and non-LD group on rates of meningitis ( P = .0530). Insertion-related complications included 2 patients (1.4%) with LDs who were not adequately draining CSF immediately postoperatively because of obstructions, 2 patients (1.4%) requiring multiple LD insertion attempts, and 1 patient (0.9%) experiencing CSF over-drainage, resulting in severe pneumocephalus and seizures without long-term neurological sequelae. There were no complications related to LD removal, including retained or broken catheters.

Patients with high-flow intraoperative CSF leaks who underwent LD placement for EES tend to have larger, more invasive tumors often requiring extended approaches. Patients undergoing LD placement should be monitored closely for complications; however, LDs are generally well tolerated.