Intraoperative Lumbar Drain Placement in Endoscopic Neurosurgical Procedures: Technical Challenges and Complications-A Prospective Observational Study

Abstract

Background  Perioperative placement of lumbar drain (LD) is being increasingly preferred in the endoscopic base of skull procedures to provide optimal surgical conditions. This study aims to determine the incidence of technical difficulties and complications associated with LD placement. Materials and Methods  A total of 50 patients undergoing transnasal transsphenoidal surgery were included in the study after obtaining written informed consent. Intraoperatively, LD was placed using an 18-gauge epidural catheter. Technical difficulties in LD placement were assessed by the number of attempts, levels attempted, difficulty in siting catheter, and obtaining free flow of cerebrospinal fluid (CSF). The incidence of complications such as postdural puncture headache (PDPH), meningitis headache, and backache was studied. Results  Successful LD placement in the first attempt was obtained in 36% of the patients. Technical difficulties were encountered in 64% of the patients. Despite successful LD placement in 90% of the patients, 32% required manipulations to increase CSF flow. The drain failure rate was 10%. Drainage of >20 to 30 mL of CSF/hour was significantly associated with better surgical conditions (p < 0.05). The incidence of headache was 56% and that of backache was 26%. Headache was significantly related to difficulty in tapping CSF (p = 0.032), and backache was significantly related to the number of attempts (p < 0.001), levels attempted (p = 0.001), and large CSF volume (p = 0.004). There were no incidences of PDPH or meningitis in our series. Conclusion  We conclude that the incidence of technical difficulties in LD placement with epidural catheters is high. Use of standard well-functioning LD catheters will assist in improving surgical conditions.