Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula.

One hundred and seven patients who had a lumbar subarachnoid catheter (teflon or silicone) placed for closed continuous cerebrospinal fluid (CSF) drainage between 1983-1991 are presented. Overall, the drain was successful in achieving the desired goal in 101 of 107 (94%) cases. There were no deaths. Five of 107 (5%) patients developed infections including two cases (2%) of meningitis. There were three cases (3%) of overdrainage with temporary neurologic decline, but all recovered. Five of fifteen (33%) teflon catheters required replacement because of occlusion, but only 5 of 92 (5%) silicone catheters required replacement. Transient lumbar nerve root irritation was seen in 15 of 107 (14%) patients treated for a CSF fistula, and all symptoms resolved after drain removal. CSF fistula/pseudomeningocele after spine surgery was cured by CSF drainage in 36 of 39 (92%) cases; there was a 10% incidence of infection (1 wound, 2 discitis, 1 meningitis). CSF fistula after cranial surgery was cured in 22 of 25 (87%) cases; there was 1 case of (4%) infection and 1 case (4%) of overdrainage. A drain was used to augment a tenuous dural closure in 38 patients with 100% success; no infection occurred and there were 2 cases (5%) of overdrainage. Five patients were successfully treated for traumatic CSF rhinorrhea/otorrhea without complications. The silicone catheter appears superior to the teflon catheter; however, both are simple, safe, and efficacious for the treatment or prevention of CSF fistulas.