Evaluating the Role of Pre-operative Cerebrospinal Fluid Diversion by Lumbar Drain in Transnasal Transsphenoidal Tumor Surgeries

Background and Aim: The major concerns related to the Endoscopic Endonasal Transsphenoidal (EET) surgery for sellar and suprasellar tumors include the risks of post-operative Cerebrospinal Fluid (CSF) leak, leading to morbidity and at times mortality, due to severe meningitis. Time is required to develop possible preventive measures that can reduce the risk of post-operative CSF rhinorrhea. The present study aimed to evaluate the effects of pre-operative CSF diversion by lumbar drainage in EET tumor surgeries on preventing post-operative CSF leak and its effect on the length of hospital stay. Methods and Materials/Patients: We conducted a prospective study on ۲۰ patients with a pituitary tumor that underwent EET surgery between October ۲۰۱۸ and December ۲۰۱۹. Preoperative Lumbar Drain (LD) was inserted after induction in all explored patients. The tumor was excised with continuous intraoperative CSF drainage. Post-operatively, the LD was kept for ۳ days and clamped for the next ۲۴ hours. If no evidence of CSF rhinorrhea was present, it was removed. Complications related to CSF drainage, CSF leak, and hospital stays were evaluated. Results: Our study population consisted of ۱۳(۶۵%) men and ۷(۳۵%) women, with Mean±SD age of ۳۹.۸±۱۰.۷۱ years. The most commonly presented complaint was visual disturbance (۶۰%) and the least common symptom was urinary disturbance (۵%). The intra-operative leak was detected in ۹(۴۵%) patients, while the post-operative leak was present in only ۱(۵%) patient. LD blockage significantly contributed to post-operative CSF leak (P=۰.۰۰۱). The Mean±SD hospital stay in the post-operative period was ۸.۸۵±۳.۲۲ days with ۶۵% of patients having a hospital stay of <۷ days. Other post-operative complications (e.g. diabetes insipidus, electrolyte imbalance, and hormonal disturbances) were mainly responsible for prolonged post-operative hospital stay (P=۰.۰۰۱). Conclusion: Pre-operative LD, apart from helping to reduce the incidence of post-operative CSF leak, is not associated with an overall increased post-operative hospital stay.