Intraoperative Lumbar Subarachnoid Drain Placement—Challenges and Complications

Background: Lumbar subarachnoid drain (LSAD) is a closed sterile catheter system placed in the lumbar subarachnoid space to drain cerebrospinal fluid (CSF) perioperatively to assist in endoscopic skull base surgeries. The placement and use of LSAD are associated with technical challenges and complications.

Materials and Methods: This prospective observational study was conducted after IRB approval. All patients planned for endoscopic TNTS/skull base tumor excision requiring LSAD were studied. LSAD was placed using 18-G epidural catheter either under GA or under LA according to the discretion of the anesthesiologist. The following parameters were noted: number of attempts, number of levels attempted for identifying the space, siting the catheter and for free flow of CSF and the volume of CSF drained. The primary investigator followed up all patients and documented complications associated with the LSAD as per defined criteria.

Results: A total of 50 patients were studied. Only in 18 patients (36%) the tapping and siting was done at 1st attempt, rest 32/50 had difficulty in placing either for tapping (29/32) or siting the catheter (15/32). Fifteen patients needed>2attemptsandin13/32patients,itwastriedin≥2 levels. In 16/50 patients needed manipulation for free flow of CSF. 23/50 patients had head ache, 13/50 had backache which had correlated with number of attempts. No patient had meningitis, paresthesia, nerve root irritation, or PDPH needing epidural blood patch.

Conclusions: Though the rate of technical difficulties while placing LSAD using the epidural catheter was unacceptably high, the incidence of major complications was lower in our series.

Publikationsverlauf

Artikel online veröffentlicht:
25. März 2020