Adams Austin S, Russell Paul T, Duncavage James A, Chandra Rakesh K, Turner Justin H
From the Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Am J Rhinol Allergy. 2016 Nov 1;30(6):424-429. doi: 10.2500/ajra.2016.30.4371.
Lumbar drains (LD) are commonly used during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea, either to facilitate graft healing or to monitor CSF fluid dynamics. However, the indications and necessity of LD placement remains controversial. The current study sought to evaluate endoscopic CSF leak repair outcomes in the setting of limited LD use.
Patients who underwent endoscopic repair of CSF rhinorrhea between 2004 and 2014 were identified by a review of medical records. Demographic and clinical data were extracted and compared between patients who had surgery with and patients who had surgery without a perioperative LD. A univariate analysis was performed to identify factors predictive of recurrence.
A total of 107 patients (116 surgical procedures) were identified, with a mean follow-up of 15.8 months. Eighty-eight of 107 patients (82.2%) had surgery without an LD. The mean hospital stay was 4.48 days in the LD group versus 1.03 days in the non-LD group (p < 0.00001). There was no difference in recurrence rate between the LD and non-LD groups. Predictors of recurrence included repair technique (p = 0.04) and size of defect (p = 0.005). Body mass index, leak site (ethmoid, sphenoid, frontal), and etiology (spontaneous, iatrogenic, traumatic) were not predictive of leak recurrence.
Use of LDs in endoscopic CSF leak repair was not associated with reduced recurrence rates, regardless of leak etiology, and resulted in a significant increase in hospital length of stay. Although the use of perioperative LDs to monitor CSF dynamics may have some therapeutic and diagnostic advantages, it may not be associated with clinically significant improvements in patient outcomes or recurrence rates.
腰大池引流（LD）常用于脑脊液（CSF）鼻漏的内镜修复术中，以促进移植物愈合或监测脑脊液动力学。然而，LD置管的适应证和必要性仍存在争议。本研究旨在评估在有限使用LD的情况下内镜脑脊液漏修补的效果。
通过查阅病历确定2004年至2014年间接受内镜脑脊液鼻漏修补术的患者。提取人口统计学和临床数据，并比较围手术期使用LD和未使用LD的患者。进行单因素分析以确定预测复发的因素。
共确定107例患者（116例手术），平均随访15.8个月。107例患者中有88例（82.2%）手术时未使用LD。LD组的平均住院时间为4.48天，而非LD组为1.03天（p<0.00001）。LD组和非LD组的复发率无差异。复发的预测因素包括修复技术（p=0.04）和缺损大小（p=0.005）。体重指数、漏口部位（筛窦、蝶窦、额窦）和病因（自发性、医源性、外伤性）不能预测漏口复发。
在内镜脑脊液漏修补术中使用LD与复发率降低无关，无论漏口病因如何，且会导致住院时间显著延长。虽然围手术期使用LD监测脑脊液动力学可能具有一些治疗和诊断优势，但它可能与患者预后或复发率的临床显著改善无关。
