Role of the External Lumbar Drain in Management of CSF Leak during or after Transsphenoidal Surgery

Background: CSF leak during or after transsphenoidal surgery is the most common annoying complication that may lead to fatal meningitis. Objective: To define the effectiveness of the external CSF lumbar drain to stop the leak either inserted preoperative, immediate postoperative or delayed postoperative with the same figure of packing to the sella turcica and sphenoid sinus. Methods: We retrospectively reviewed a series of 200 consecutive transsphenoidal surgery for pituitary adenoma, half of cases with intra-operative leak managed with packing only, the another half is managed by pack with CSF lumbar drain. Results: Leak stopped in all cases with lumbar drain except one case 19/20 (99.5%), leak stopped in this case after repacking with lumbar drain, while in cases managed with packing only, leak stopped in 13/20 (65%), leak stopped in 6/7 (85.7%) after lumbar drain, while in the seventh case, the leak did not stop after repacking with lumbar drain but stopped after lumboperitoneal shunt. Conclusion: CSF external lumbar drain markedly reduces the incidence of postoperative leak and also solves the problem of persistent postoperative leak either alone or with repacking. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 483-488]