LDs Reduce CSF Leaks in Endoscopic Skull Base Surgery for Large Dural Defects

Classic Article Review  –  Background: Endoscopic endonasal surgery (EES) for skull base pathology carries a well-known risk of postoperative cerebrospinal fluid (CSF) leaks. The clinical utility of using prophylactic lumbar drainage (LD) to mitigate this complication has remained a topic of debate. Objective: To determine whether postoperative placement of a lumbar drain following standard reconstruction—specifically using a vascularized nasoseptal flap—effectively reduces the incidence of CSF leaks after EES for intradural pathology. High-risk inclusion criteria required a dural defect >1 cm 2 , accompanied by extensive arachnoid dissection or entry into a ventricle or cistern. Design: Prospective, randomized controlled trial. Participants/Methods: 170 patients undergoing EES with planned reconstruction were randomized into an intervention group receiving a lumbar drain (n=85) and a control group managed without a drain (n=85). Baseline demographics, including age and more...