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Incidence of CSF leak following skull base surgery

1Cleland S, 2Toma A, 2Luoma V, 2Reddy U, 2Bradford R
1The Royal Marsden Hospital, London, London, UK; 2National Hospital for Neurology and Neurosurgery, London, , UK

Introduction
Cerebro-spinal fluid [CSF] pressures increase following skull base surgery and the resulting post-operative CSF leak is a recognized complication with a reported incidence of up to 10.7%(1). Common treatments of CSF leak include conservative management, continuous external lumbar CSF drainage and surgical exploration. It is our normal practice to insert a pre-operative lumbar drain to facilitate CSF drainage to reduce incidence of CSF leak in patients undergoing translabyrinthine craniotomy.

Aims
1. To compare incidence of CSF leak between different surgical approaches and with the use of elective perioperative lumbar drainage
2. To quantify the complication rate associated with lumbar drainage in this patient population

Methods
A retrospective case-note review of all patients undergoing skull base surgery from January 2010 to July 2013 was performed. Data collected included demographics, surgical data and, use and complications of lumbar drains.

Results
103 cases identified, 100 case-notes reviewed. Incidence of post-operative CSF leaks was 8% [table 1] with 5 readmissions following discharge from hospital. Management of CSF leaks included:
1. Conservative treatment: 0
2. Surgical treatment alone: 1
3. Lumbar CSF drainage: 7 [5 required further surgical intervention and 1 had a VP shunt inserted]

52 lumbar drains were inserted, 8 to treat CSF leaks. The mean [SD] duration [days] of CSF drainage was 2.4 [± 0.6] for perioperative and 4 [±1.7] for treatment of CSF leak. We found no association between duration of lumbar drainage and post-operative CSF leaks. Incidence of complications was low and most commonly minor [graph 1] with no lumbar drain related infections during this time.

Conclusions
Incidence of post-operative CSF leaks [8%] at our institution is comparable with published data, and similar between different surgical approaches. Although not statistically significant, use of a perioperative lumbar drainage reduced the incidence of CSF leak in a translabyrinthine approach. The use of lumbar drains post-operatively to treat CSF leak is often insufficient. The majority of patients required further surgical intervention, similar to data published from other institutions(2). Continuous lumbar CSF drainage in this group of patients appears to be a safe procedure with only minor complications, largely mechanical.
References:
1. Brennan et al J Neurosurg. 2001; 94:217-223
2. Becker et al Otol Neurotol 2003; 24[1]:107-12

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