Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suarez," Mexico City, Mexico.
Oper Neurosurg (Hagerstown). 2018 Jan 1;14(1):66-71. doi: 10.1093/ons/opx070.
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.
To compare the rates of postoperative CSF leak between patients with and without LD who underwent endonasal endoscopic surgical resection of suprasellar meningiomas.
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.
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).
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.
经鼻内镜手术后，脑脊液（CSF）漏仍然是一种持续存在但不太明显的并发症，尤其是在鞍上脑膜瘤患者中。具有最高风险的病变是鞍上脑膜瘤。术后腰椎引流（LD）用于降低 CSF 漏的风险，但并未被普遍接受。
比较接受经鼻内镜手术切除鞍上脑膜瘤的患者中，有无术后 LD 的患者 CSF 漏的发生率。
从我院前瞻性获取的经鼻内镜手术数据库中抽取了一系列新诊断的鞍上脑膜瘤患者。在手术前放置了术中预切开 LD，并以 5 cc/h 的速度开放约 48 小时。在一部分患者中，无法放置 LD。比较有和无 LD 的患者术后 CSF 漏的发生率。
25 例患者接受了经鼻内镜手术切除鞍上脑膜瘤。有 2 例患者无法放置 LD。术后发生 2 例 CSF 漏（8%），均发生在未放置 LD 的患者中（P =.0033）。无法放置 LD 的患者的平均体重指数（BMI）为 39.1 kg/m2，而可放置 LD 的患者的 BMI 为 27.6 kg/m2（P =.009）。在肥胖患者亚组（BMI > 30 kg/m2）中，LD 放置可预防术后 CSF 漏（P =.022）。
肥胖患者无法放置 LD 是术后 CSF 漏的危险因素。LD 可能有助于预防术后 CSF 漏，尤其是在 BMI 升高的患者中。
