These two separate papers neatly tie together the same ideas. The first, a retrospective study of 107 patients and 116 procedures over a 10-year period who underwent a CSF leak repair, 82.2% without a lumbar drain and 17.8% with. The primary and secondary success rates for surgery were equivocal between the two groups, the rate being even slightly higher (although not statistically significant) in the lumbar drain group. The authors conclude that the use of a lumbar drain did not reduce the recurrence rates, but did significantly increase the hospital stay.
A meta-analysis of use of lumbar drains in CSF leak repair found five studies, and a total of 376 cases for analysis. The authors found no convincing evidence to support the use of lumbar drains postoperatively, with respect to the postoperative CSF leak rate, in fact in harmony with the previous study, found a slightly higher rate in the lumbar drain group. Although this may well represent selection bias as lumbar drains were selected for the patients with the largest defects and the highest volume leaks, it is certainly an interesting finding. Although the evidence is confounded by analysis of multiple repair types, sites and defects, these findings both suggest that use of lumbar drains need not be ubiquitous and may not improve outcomes.
Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhoea without lumbar drains.
Adams A, Russel P, Dunvagave J, et al.
AMERICAN JOURNAL OF RHINOLOGY AND ALLERGY
2016;30(6):424-9.
and
