Faculty Collaboration Database

Lumbar drains: Practical understanding and application for the otolaryngologist. Am J Otolaryngol 2020;41(6):102740

Date

09/27/2020

Pubmed ID

32979671

DOI

10.1016/j.amjoto.2020.102740

Scopus ID

2-s2.0-85091225239 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

INTRODUCTION: Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to modulate CSF pressure. Within otolaryngology, lumbar drains are most frequently used for cerebrospinal fluid leaks - either due to cerebrospinal fluid fistulas or in skull base surgery as these allow for potential healing of the defect. While not typically placed by otolaryngologists, a basic understanding of lumbar drains is beneficial in the context of patient management.

MANAGEMENT: A lumbar drain is inserted into the intrathecal space in a patient's lumbar spine. Though considered to be a benign procedure, complications are relatively frequent, and adjustment or replacement of the drain may be required. Complications include infection, epidural bleeding, retained hardware, sequelae of relative immobility, or may relate to over-drainage, ranging from mild headache to cranial neuropathies, altered mental status, pneumocephalus, intracranial hemorrhage, and death. While in place, neurologic exams should be performed routinely and should include motor and sensory exams of the lower extremities. A patient should be monitored for fevers, nuchal rigidity, and other signs of infection or meningitis. The CSF fluid should be grossly examined to identify changes, but routine laboratory tests are not typically run on the fluid itself. Drainage rates will vary usually between 5 and 20 mL per hour and must be frequently reassessed and adjusted based upon signs of intracranial hypotension. Drains should be removed when appropriate and should not be left in more than 5 days due to the increased infectious risk.

CONCLUSION: Lumbar drains are important tools used in patients with otolaryngologic pathologies. Otolaryngologists and otolaryngology residents should be familiar with these catheters to determine if they are working correctly and to identify adverse effects as early as possible.

Author List

Livingston AJ, Laing B, Zwagerman NT, Harris MS

Authors

Michael S. Harris MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Nathan Zwagerman MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cerebrospinal Fluid Leak
Device Removal
Drainage
Humans
Intracranial Hypotension
Lumbar Vertebrae
Otolaryngologists
Postoperative Complications
Time Factors