Perioperative lumbar drain placement: An independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery

Abstract

Objective: To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications. Design: Retrospective review of a series of patients (n = 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n = 45) underwent routine lumbar drain placement at the time of skull base surgery. The remainder of the series did not undergo routine perioperative lumbar drain placement. Intervention: Transglabellar/subcranial surgical approach to the anterior skull base, with or without routine perioperative lumbar drain placement. Results: Routine placement of perioperative lumbar drains was an independent predictor of tension pneumocephalus ( P =.022, odds ratio = 11.22 [1.218–103.3]). In addition, this practice was also associated with an increased risk of intracranial complications overall ( P =.025, odds ratio = 2.623 [1.104–6.233]). Conclusion: Routine placement of perioperative lumbar drain may be associated with an increased risk of tension pneumocephalus and intracranial complications during surgery of the anterior cranial base. Laryngoscope, 2011