A Prospective Study To Evaluate The Role Of Perioperatve Cerebrospinal Fluid Diversion By Lumbar Drain In Transnasal Transsphenoidal Tumor Surgeries

Background &Aim: The endoscopic endonasal transsphenoidal approach has been widely employed as a treatment for pituitary adenomas and other parasellar tumors. However, the major concerns related to endoscopic endonasal transsphenoidal surgery include the risks of CSF leak post-operatively leading to morbidity and at times mortality due to severe meningitis. Several studies in the past have found a strong correlation between CSF rhinorrhea and intracranial infections. It is the need of time to develop possible preventive measures that can reduce the risk of postoperative CSF rhinorrhea. The aim of our study was to evaluate the efficacy of perioperative CSF diversion by lumbar drainage in endoscopic transsphenoidal tumor surgeries in preventing postoperative cerebrospinal fluid (CSF) leak and effect on length of hospital stay. Methods: We conducted a prospective study on 20 patients of a pituitary tumor in our institution that underwent endoscopic transnasal transsphenoidal surgery between Oct 2018 and Dec 2019.  Perioperative lumbar drain (LD) was inserted in all patients in lateral decubitus position. The Tumor was excised in a standard manner with continuous CSF drainage intraoperatively. Postoperatively the lumbar drain was kept for 3 days and clamped for the next 24 hours. If no evidence of CSF rhinorrhea was present, then it was removed. Complications related to CSF drainage, the effect of a lumbar drain on tumor resection, CSF leak, and hospital stay was evaluated. Results: Our study population consisted of 20 patients, 13 men (65%) and 7 women (35%), with a mean age of 39.8 +/-10.71 years. The youngest one was 24 years and the oldest one was 60 years. Most commonly the presenting complaint was visual disturbance (60%) and the least common symptom was urinary disturbance (5%). The intra-operative leak was seen in 9 patients (45%) while the post-operative leak was present in only 1 patient (5%). There was no effect of tumor extension and functional status of tumor on intraoperative CSF leak.     Lumbar drain blockage was a significant factor contributing to post-operative CSF leak (p =0.001). Mean hospital stay in the postoperative period was 8.85 +/- 3.22 days with 65% of patients having a hospital stay of < 7 days. Other postoperative complications (e.g. Diabetes insipidus, electrolyte imbalance, and hormonal disturbances) were mainly responsible for prolonged postoperative hospital stay (p=0.001) Conclusion: Lumbar drain apart from helping to reduce   the incidence of postoperative CSF leak following transsphenoidal surgery it also helps in significant resolution of patient symptoms   Peroperative lumbar drainage is not associated with an overall increased postoperative hospital stay.