Acta Neurochirurgica

, Volume 159, Issue 8, pp 1379–1385 | Cite as

Predictors and incidence of orthostatic headache associated with lumbar drain placement following endoscopic endonasal skull base surgery

  • Buqing Liang
  • Sathwik R. Shetty
  • Sacit Bulent Omay
  • Joao Paulo Almeida
  • Shilei Ni
  • Yu-Ning Chen
  • Armando S. Ruiz-Treviño
  • Vijay K. Anand
  • Theodore H. Schwartz
Original Article - Neurosurgical Techniques

Abstract

Background

Orthostatic headache (OH) is a potential complication of lumbar drainage (LD) usage. The incidence and risk factors for OH with the use of lumbar drainage during endoscopic endonasal procedures have not been documented.

Objective

To investigate the incidence of post-procedure OHs associated with placement of LD in patients undergoing endoscopic endonasal procedures.

Methods

We prospectively noted the placement of LDs in a consecutive series of endoscopic endonasal skull base surgeries. Charts were retrospectively reviewed, and patients were divided into two groups: those with OH and those without. The patient demographics, drain durations, imaging findings of intracranial hypotension, pathologies and need for a blood patch were compared between the two groups.

Results

Two hundred forty-nine patients were included in the study. Seven patients (2.8%) suffered post-dural puncture OH, which was mild to moderate and disappeared 2–8 days (median 3 days) after treatment. Blood patches were used in four patients. Significant predisposing factors were age (33.0 vs. 53.5, P = 0.014) and a strong trend for female gender (85.7% vs. 47.9%, P = 0.062). BMI and drain duration were not significant. Postoperative intracranial hypotension was diagnosed radiographically in 43% of OH patients and in 5.4% of those without OH (P = 0.003). Four (1.6%) patients required treatment with an epidural blood patch.

Conclusion

OH associated with intracranial hypotension in patients undergoing endoscopic endonasal procedures with LDs is an infrequent complication seen more commonly in young female patients. Radiographic signs of intracranial hypotension are a specific but not sensitive test for OH.

Keywords

Craniopharyngioma Lumbar drain Meningioma Orthostatic headache Pituitary adenoma Endoscopic endonasal approach Skull base 

Notes

Compliance with ethical standards

Conflict of interest

None.

Disclosure of funding

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethical standards. This study was approved by the hospital’s institutional review board, and consents were waived.

References

  1. 1.
    Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD (2004) Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope 114(2):266–272CrossRefPubMedGoogle Scholar
  2. 2.
    Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH (2007) Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 61(3 Suppl):161–165 discussion 165–6PubMedGoogle Scholar
  3. 3.
    Ransom ER, Palmer JN, Kennedy DW, Chiu AG (2011) Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery. Int Forum Allergy Rhinol 1(3):173–177CrossRefPubMedGoogle Scholar
  4. 4.
    Roland PS, Marple BF, Meyerhoff WL, Mickey B (1992) Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg 107(4):564–569CrossRefPubMedGoogle Scholar
  5. 5.
    Tien DA, Stokken JK, Recinos PF, Woodard TD, Sindwani R (2016) Cerebrospinal fluid diversion in endoscopic skull base reconstruction: an evidence-based approach to the use of lumbar drains. Otolaryngol Clin N Am 49(1):119–129CrossRefGoogle Scholar
  6. 6.
    Dieterich M, Perkin GD (1996) Post-lumbar puncture headache syndrome. In: Brand T, Caplan LR, Dichland J et al (Eds) Neurologic disorders: course and treatment. Academic Press, San Diego, p 59Google Scholar
  7. 7.
    Hammond ER, Wang Z, Bhulani N, McArthur JC, Levy M (2011) Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. J Neurol Sci 306(1–2):24–28CrossRefPubMedGoogle Scholar
  8. 8.
    Hirono S, Kawauchi D, Higuchi Y et al (2015) Life-threatening intracranial hypotension after skull base surgery with lumbar drainage. J Neurol Surg Rep 76(1):e83–e86CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Amorim JA, Gomes de Barros MV, Valença MM (2012) Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia 32(12):916–923CrossRefPubMedGoogle Scholar
  10. 10.
    Hulou MM, Abd-El-Barr MM, Gormley WB, Zamani AA, Dunn IF, Al-Mefty O (2016) The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle. Br J Neurosurg 30(4):438–443CrossRefPubMedGoogle Scholar
  11. 11.
    Ahmed SV, Jayawarna C, Jude E (2006) Post lumbar puncture headache: diagnosis and management. Postgrad Med J 82(973):713–716CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lybecker H, Møller JT, May O, Nielsen HK (1990) Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg 70(4):389–394CrossRefPubMedGoogle Scholar
  13. 13.
    Sun-Edelstein C, Lay CL (2016) Post-lumbar puncture headache. In: UpToDate Online. uptodate.com/contents/post-lumbar-puncture-headache. Accessed 24 Sep 2016
  14. 14.
    Inenaga C, Tanaka T, Sakai N, Nishizawa S (2001) Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension. Case report Journal of Neurosurgery 94(4):642–645CrossRefPubMedGoogle Scholar
  15. 15.
    Wilton NC, Globerson JH, de Rosayro AM (1986) Epidural blood patch for postdural puncture headache: it’s never too late. Anesth Analg 65(8):895–896CrossRefPubMedGoogle Scholar
  16. 16.
    Paldino M, Mogilner AY, Tenner MS (2003) Intracranial hypotension syndrome: a comprehensive review. Neurosurg Focus. doi: 10.3171/foc.2003.15.6.8
  17. 17.
    Pattichis AA, Slee M (2016) CSF hypotension: a review of its manifestations, investigation and management. J Clin Neurosci. doi: 10.1016/j.jocn.2016.07.002
  18. 18.
    Hart JR, Whitacre RJ (1951) Pencil-point needle in prevention of postspinal headache. J Am Med Assoc 147(7):657–658CrossRefPubMedGoogle Scholar
  19. 19.
    Strupp M, Schueler O, Straube A, Stuckrad Barre Von S, Brandt T (2001) “atraumatic” Sprotte needle reduces the incidence of post-lumbar puncture headaches. Neurology 57(12):2310–2312CrossRefPubMedGoogle Scholar
  20. 20.
    Kitchel SH, Eismont FJ, Green BA (1989) Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am 71(7):984–987CrossRefPubMedGoogle Scholar
  21. 21.
    Urbach H (2014) Intracranial hypotension: clinical presentation, imaging findings, and imaging-guided therapy. Curr Opin Neurol 27(4):414–424CrossRefPubMedGoogle Scholar
  22. 22.
    Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM (1992) Post-lumbar puncture headaches experience in 501 consecutive procedures. Neurology 42(10):1884–1884CrossRefPubMedGoogle Scholar
  23. 23.
    Samadani U, Huang JH, Baranov D (2003) Intracranial hypotension after intraoperative lumbar cerebrospinal fluid drainage. Neurosurgery. doi: 10.1227/01.NEU.0000039163.95716.DB
  24. 24.
    Açikbaş SC, Akyüz M, Kazan S, Tuncer R (2002) Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir 144(5):475–480CrossRefPubMedGoogle Scholar
  25. 25.
    Vandam LD, Dripps RD (1956) Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc 161(7):586–591CrossRefPubMedGoogle Scholar
  26. 26.
    de Almeida SM, Shumaker SD, LeBlanc SK, Delaney P, Marquie Beck J, Ueland S, Alexander T, Ellis RJ (2011) Incidence of post-Dural puncture headache in research volunteers. Headache: The Journal of Head and Face Pain 51(10):1503–1510CrossRefGoogle Scholar
  27. 27.
    Miu M, Paech MJ, Nathan E (2014) The relationship between body mass index and post-dural puncture headache in obstetric patients. Int J Obstet Anesth 23(4):371–375CrossRefPubMedGoogle Scholar
  28. 28.
    Andrews LE, Liu GT, Ko MW (2014) Idiopathic intracranial hypertension and obesity. Horm Res Paediatr 81(4):217–225CrossRefPubMedGoogle Scholar
  29. 29.
    Miu M, Paech M, Nathan E (2014) The relationship between body mass index and post-dural puncture headache after obstetric accidental dural puncture. Eur J Anaesthesiol 31:193–191CrossRefGoogle Scholar
  30. 30.
    Vilming ST, Kloster R, Sandvik L (2001) The importance of sex, age, needle size, height and body mass index in post-lumbar puncture headache. Cephalalgia 21(7):738–743CrossRefPubMedGoogle Scholar
  31. 31.
    Carson D, Serpell M (1996) Choosing the best needle for diagnostic lumbar puncture. Neurology 47(1):33–37CrossRefPubMedGoogle Scholar
  32. 32.
    Toyka KV, Müller B, Reichmann H (2002) “atraumatic” Sprotte needle reduces the incidence of post-lumbar puncture headaches. Neurology 59(7):1120 author reply 1120–1CrossRefPubMedGoogle Scholar
  33. 33.
    Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. doi: 10.1093/bja/aeg231
  34. 34.
    Antony J, Hacking C, Jeffree RL (2015) Pachymeningeal enhancement-a comprehensive review of literature. Neurosurg Rev 38(4):649–659CrossRefPubMedGoogle Scholar
  35. 35.
    Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW (2007) Patterns of contrast enhancement in the brain and meninges. Radiographics 27(2):525–551CrossRefPubMedGoogle Scholar
  36. 36.
    Mokri B (1999) Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia—evolution of a concept. Mayo Clin Proc 74(11):1113–1123CrossRefPubMedGoogle Scholar
  37. 37.
    Kaya D, Soysal P, Isık AT (2015) Intracranial hypotension-like syndrome after a spinal tap test performed for idiopathic normal pressure hydrocephalus. Am J Alzheimers Dis Other Demen 30(6):569–572CrossRefPubMedGoogle Scholar
  38. 38.
    Grady RE, Horlocker TT, Brown RD, Maxson PM, Schroeder DR (1999) Neurologic complications after placement of cerebrospinal fluid drainage catheters and needles in anesthetized patients: implications for regional anesthesia. Mayo perioperative outcomes group. Anesth Analg 88(2):388–392PubMedGoogle Scholar
  39. 39.
    Duffy PJ, Crosby ET (1999) The epidural blood patch. Resolving the controversies. Can J Anaesth 46(9):878–886CrossRefPubMedGoogle Scholar
  40. 40.
    Berrettini WH, Simmons-Alling S, Nurnberger JI (1987) Epidural blood patch does not prevent headache after lumbar puncture. Lancet 1(8537):856–857CrossRefPubMedGoogle Scholar
  41. 41.
    Cohen S, Schwartz T, Anand V (2016) Lumbar drains decrease the risk of post-operative cerebrospinal fluid (CSF) leak following extended endonasal endoscopic surgery for suprasellar meningiomas in patients with high BMI. J Neurol Surg B Skull Base. doi: 10.1055/s-0036-1579969
  42. 42.
    Zwagerman N, Shin S, Wang E, Fernandez-Miranda J, Snyderman C, Gardner P (2016) A prospective. randomized control trial for lumbar drain placement after endoscopic endonasal skull base surgery, J Neurol Surg B Skull Base. doi: 10.1055/s-0036-1592620

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Buqing Liang
    • 1
  • Sathwik R. Shetty
    • 1
  • Sacit Bulent Omay
    • 1
  • Joao Paulo Almeida
    • 1
  • Shilei Ni
    • 1
  • Yu-Ning Chen
    • 1
  • Armando S. Ruiz-Treviño
    • 1
  • Vijay K. Anand
    • 2
  • Theodore H. Schwartz
    • 1
    • 2
    • 3
  1. 1.Department of NeurosurgeryWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  2. 2.Department of OtolaryngologyWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  3. 3.Department of NeuroscienceWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA

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