Risk of Brain Herniation After Craniotomy With Preoperative Lumbar Spinal Drainage : A Single-Surgeon Experience of 365 Patients Among 3000 Major Cranial Cases

Copyright © 2020 by the Congress of Neurological Surgeons..

BACKGROUND: Lumbar spinal drainage (LSD) can significantly facilitate brain relaxation and improve ease of surgical goals for a variety of neurosurgical indications. Although rapid drainage of large volumes of spinal fluid can theoretically produce shifts in brain compartments and herniation syndromes, the clinical significance of this phenomenon when LSD is used immediately before craniotomy is unclear.

OBJECTIVE: To report a large single-surgeon consecutive experience with symptomatic brain herniation after lumbar drainage before craniotomy.

METHODS: Included were 365 patients who underwent LSD with either lumbar drain or lumbar puncture for a variety of different neurosurgical pathologies between 2008 and 2018 immediately before craniotomy. We reviewed the surgical indications, craniotomy location, approach, type of LSD, presence of postoperative brain herniation on imaging, type of herniation, clinical symptoms, lesion pathology, and 30-d modified Rankin Scale score for each patient.

RESULTS: There was no patient who suffered from the development of new or worsening symptomatic or radiological brain herniation directly related to use of immediate preoperative LSD. This included 204 supratentorial and 161 infratentorial procedures. Surgical indications included 188 tumors, 5 aneurysms, 37 arteriovenous malformations, 2 revascularization procedures, 97 microvascular decompressions, 10 optic nerve decompressions requiring extradural clinoidectomy for tumor removal, and 26 "other" pathologies.

CONCLUSION: Brain herniation did not occur postoperatively with the use of immediate preoperative LSD in our series, regardless of craniotomy location, pathology, extent of mass effect, or approach. Our experience suggests that LSD is a potentially safe preoperative adjunct that can be used to facilitate surgical objectives.

Errataetall:

CommentIn: Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E83-E84. - PMID 33305791

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:20

Enthalten in:

Operative neurosurgery (Hagerstown, Md.) - 20(2021), 2 vom: 13. Jan., Seite E77-E82

Sprache:

Englisch

Beteiligte Personen:

Lane, Brandon C [VerfasserIn]
Scranton, Robert [VerfasserIn]
Cohen-Gadol, Aaron A [VerfasserIn]

Links:

Volltext

Themen:

Brain herniation
Journal Article
Lumbar drain
Lumbar puncture
Lumbar spinal drainage

Anmerkungen:

Date Completed 21.06.2021

Date Revised 21.06.2021

published: Print

CommentIn: Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E83-E84. - PMID 33305791

Citation Status MEDLINE

doi:

10.1093/ons/opaa262

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM313970084