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Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study

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Abstract

The efficacy of spinal drain (SD) placement for cerebrospinal fluid (CSF) leakage prevention after the anterior transpetrosal approach (ATPA) remains unclear. Thus, we aimed to assess whether postoperative SD placement improved postoperative CSF leakage after a skull base reconstruction procedure using a small abdominal fat and pericranial flap and clarify whether bed rest with postoperative SD placement increased the length of hospital stay. This retrospective cohort study included 48 patients who underwent primary surgery using ATPA between August 2011 and February 2022. All cases underwent SD placement preoperatively. First, we evaluated the necessity of SD placement for CSF leakage prevention by comparing the postoperative routine continuous SD placement period to a period in which the SD was removed immediately after surgery. Second, the effects of different SD placement durations were evaluated to understand the adverse effects of SD placement requiring bed rest. No patient with or without postoperative continuous SD placement developed CSF leakage. The median postoperative time to first ambulation was 3 days shorter (P < 0.05), and the length of hospital stay was 7 days shorter (P < 0.05) for patients who underwent SD removal immediately after surgery (2 and 12 days, respectively) than for those who underwent SD removal on postoperative day 1 (5 and 19 days, respectively). This skull base reconstruction technique was effective in preventing CSF leakage in patients undergoing ATPA, and postoperative SD placement was not necessary. Removing the SD immediately after surgery can lead to earlier postoperative ambulation and shorter hospital stay by reducing medical complications and improving functional capacity.

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Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Aichi, Toyoake City, 470-1192, Japan

    Kazuhide Adachi, Mitsuhiro Hasegawa & Yuichi Hirose

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  1. Kazuhide Adachi
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  2. Mitsuhiro Hasegawa
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  3. Yuichi Hirose
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Contributions

All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by Kazuhide Adachi, Mituhiro Hasegawa, and Yuichi Hirose. The first draft of the manuscript was written by Kazuhide Adachi, and all authors commented on the early versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kazuhide Adachi.

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Ethics approval

This retrospective cohort study was approved by the institutional review board of Fujita Health University Hospital (approval number HM21-525).

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An opt-out method was used for all potential study participants. Written informed consent is not required in opt-out approach as all participants are included in the study unless they express their desire to be excluded.

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The participants have all consented to submitting their case report for journal publication.

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The authors declare no competing interests.

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Adachi, K., Hasegawa, M. & Hirose, Y. Cerebrospinal fluid leakage prevention using the anterior transpetrosal approach with versus without postoperative spinal drainage: an institutional cohort study. Neurosurg Rev 46, 137 (2023). https://doi.org/10.1007/s10143-023-02045-w

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