Lumbar Drains Decrease the Risk of Postoperative Cerebrospinal Fluid Leak Following Endonasal Endoscopic Surgery for Suprasellar Meningiomas in Patients With High Body Mass Index.
BACKGROUND
Postoperative cerebrospinal fluid (CSF) leak is a persistent, albeit much less prominent, complication following endonasal endoscopic surgery. The pathology with highest risk is suprasellar meningiomas. A postoperative lumbar drain (LD) is used to decrease the risk of CSF leak but is not universally accepted.


OBJECTIVE
To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas.


METHODS
A consecutive series of newly diagnosed suprasellar meningiomas was drawn from a prospectively acquired database of endonasal endoscopic surgeries at our institution. An intraoperative, preresection LD was placed and left open at 5 cc/h for ∼48 h. In a subset of patients, the LD could not be placed. Rates of postoperative CSF leak were compared between patients with and without an LD.


RESULTS
Twenty-five patients underwent endonasal endoscopic surgical resection of suprasellar meningiomas. An LD could not be placed in 2 patients. There were 2 postoperative CSF leaks (8%), both of which occurred in the patients who did not have an LD (P = .0033). The average body mass index (BMI) of the patients in whom the LD could not be placed was 39.1 kg/m2, compared with 27.6 kg/m2 for those in whom the LD could be placed (P = .009). In the subgroup of obese patients (BMI > 30 kg/m2), LD placement was protective against postoperative CSF leak (P = .022).


CONCLUSION
The inability to place an LD in patients with obesity is a risk factor for postoperative CSF leak. An LD may be useful to prevent postoperative CSF leak, particularly in patients with elevated BMI.
['Cohen|Salomon|S|', 'Jones|Samuel H|SH|', 'Dhandapani|Sivashanmugam|S|', 'Negm|Hazem M|HM|', 'Anand|Vijay K|VK|', 'Schwartz|Theodore H|TH|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015992:Body Mass Index D065634:Cerebrospinal Fluid Leak D004322:Drainage D005260:Female D006801:Humans D008297:Male D008577:Meningeal Neoplasms D008579:Meningioma D008875:Middle Aged D009765:Obesity D011183:Postoperative Complications D012307:Risk Factors D000067368:Transanal Endoscopic Surgery D016896:Treatment Outcome
Lumbar drain Cerebrospinal fluid Leak Endonasal Surgery Meningioma Endoscopy Transsphenoidal