Lumbar Drain for Temporary Cerebrospinal Fluid Diversion: Factors Related to the Risks of Complications at a University Hospital.

OBJECTIVE

Lumbar drains (LDs) are often used for temporary cerebrospinal fluid (CSF) diversion. However, limited data are available on the risk factors associated with complications. We reviewed our institutional LD data to identify the common indications and outcomes, including the risk factors associated with the occurrence of complications.

METHODS

We performed a retrospective review of the patient medical records. All adult patients, who had an LD placed at our hospital during a 5-year period, were included in the present study. The Fisher Exact test and Mann-Whitney U test were used to compare the categorical data and continuous data, respectively; p ≤ 0.05 was considered to indicate statistical significance.

RESULTS

During the study period, 211 patients had an LD placed and were included in the present study, of whom 133 were men (63.0%). The most common reason for LD placement was for an iatrogenic CSF leak and pseudomeningocele in 95 patients (45.0%). The mean duration of an indwelling LD was 3.7 ± 1.9 days. Meningitis was the most common complication after LD insertion, occurring in 12 patients (5.5%), followed by low pressure headaches in 10 patients (4.8%). Escherichia coli and Pseudomonas aeruginosa were the most common organisms on culture. Manipulation of the LD to draw CSF samples for analysis was a significant risk factor for the development of meningitis (p = 0.039).

CONCLUSIONS

The most common complications in our institution were meningitis and low pressure headaches. Minimizing LD manipulation during CSF sampling could potentially decrease the risk of meningitis. Our protocol of continuing routine prophylactic antibiotics for patients with an indwelling LD might reduce the risk of meningitis; however, the results from a prospective cohort study would provide stronger evidence.