The Effect of Perioperative Lumbar Drains in CSF Rhinorrhea after Endoscopic Repair

Abstract

Background: Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication between the subarachnoid and sinonasal spaces. Surgical repair of CSF leaks that do not respond to conservative management is indicated to seal a potentially infectious conduit. The risk of ascending meningitis in the setting of anterior skull base defects has been reported to be 10% to 37%. Aim of the Work: Is to evaluate the efficacy of perioperative lumbar drainage following endonasal endoscopic cerebrospinal fluid leak repair. Patients and Methods: A meta-analysis examining the use of lumbar drains as an adjunct therapy to endonasal endoscopic repair of CSF leaks. Our study depends on examining only the existing peer-reviewed literature, from PubMed (1990 to November 2018). Search terms included: cerebrospinal fluid leak, cerebrospinal fluid rhinorrhea, lumbar drain, endoscopic repair. The Medical Subject Headings database— a-controlled vocabulary system used for indexing articles for MEDLINE—was used to maximize our search yield. Results: Meta-analysis for efficacy of perioprative lumbar drain in cases of CSF rhinorrea following endoscopic repair was done using (20) studies with a total number of patients (1825) divided into (811) male & (879) female – not all studies are included with mean follow up (23.319) months. The results of these studies showed marked heterogeneity, so pooling of data was done with random effect model which showed a success rate of repair (estimated by recurrence of post operative leak) of 72.13% with lumbar drain & 90.08% without lumbar drain. Conclusion: In a series of 20 studies which discussed endoscopic repair of anterior cranial fossa CSF rhinorrhea, there was no association identified in this review between placement of a lumbar drain and recurrence of the leak. This lack of influence on recurrence rate was observed whether the leak was highflow or low-flow, spontaneous, traumatic, or iatrogenic in origin..