首页|The effects of cerebrospinal fluid (CSF) diversion on post-operative CSF leak following extended endoscopic anterior skull base surgery
The effects of cerebrospinal fluid (CSF) diversion on post-operative CSF leak following extended endoscopic anterior skull base surgery
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NSTL
Elsevier
? 2022 Elsevier LtdThere is a paucity of high quality evidence regarding the routine placement of lumbar drain (LD) in reducing post-operative (op) cerebrospinal fluid (CSF) leak after extended endoscopic trans-sphenoidal resection of anterior skull base lesions. In this study, we sought to compare the incidence of post-op CSF leak between patients with upfront LD insertion and those without it. This was a prospective randomized controlled trial conducted over a period of 5 years with patients undergoing extended endoscopic trans-sphenoidal surgery randomly assigned to either LD insertion at the time of surgery, or no LD placement. Thirty-eight patients with anterior skull base tumors were accrued from three tertiary hospitals of Melbourne. Post-op leak was confirmed by β2-transferrin-positive rhinorrhea, and/or worsening pneumocephalus on brain imaging. Skull base defect size and pedicled nasoseptal flap viability were assessed on post-op CT and MRI, respectively. There was no significant difference in post-op CSF leak incidence between the two subgroups (12.50% in LD arm vs. 9.10% in no LD arm). Patients with LD insertion however, demonstrated substantially raised complication rates, longer hospital lengths of stay and lower subjective quality of life measures at 12 months compared with those without LD. In conclusion, routine placement of LD at the time of surgery for extended anterior skull base trans-nasal approach did not reduce the risk of post-op CSF leak. Discretion is warranted when using LD as an adjunct due to its associated morbidities, prolonged hospital stay and adverse effect on patients’ subjective outcome measures.
Anterior skull baseCSF diversionCSF leakEndonasal endoscopic surgeryLumbar drainNasoseptal flapTrans-sphenoidal surgery
Huo C.W.、King J.、Goldschlager T.、Dixon B.、Chen Zhao Y.、Uren B.、Wang Y.Y.
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Department of Neurosurgery St Vincent's Hospital Melbourne
Department of Neurosurgery The Royal Melbourne Hospital
Department of Neurosurgery Monash Medical Centre
The Head and Neck/ENT Unit St Vincent's Hospital Melbourne
The Head and Neck/ENT Unit The Royal Melbourne Hospital
NSTL
Elsevier
