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Flow-regulated external lumbar drain: applications and complications

  • Experimental Research - Neurosurgical Techniques
  • Published:
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Abstract

Background

A novel flow-regulated external drain (FRED) was devised to overcome the problems of the pressure-regulated systems and serial lumbar taps.

Methods

Eleven patients who underwent lumbar external drainage received a flow-regulated system using simple and inexpensive materials available in most hospital settings.

Results

The system proved to be reliable at removing a set amount of cerebrospinal fluid (CSF). We did not encounter any serious complications in its application.

Conclusions

The FRED system offered better patient compliance and comfort, providing them with greater mobility, while maintaining a safer steady removal of a set amount of CSF. In opposition to the pressure-regulated systems, we describe the possible indications, advantages and disadvantages of a flow regulated device. Extensive clinical trials are needed to study the use of FRED in patients with different CSF circulation physiology, pressure and composition.

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Conflict of Interest

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Authors and Affiliations

  1. Evangelismos General Hospital of Athens, Neurosurgical department of the University of Athens, D.Ralli str. 92-94, Piraeus, 18539, Greece

    Nikitas Nanidis, Stefanos Korfias & Damianos E. Sakas

Authors
  1. Nikitas Nanidis
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  2. Stefanos Korfias
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  3. Damianos E. Sakas
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Corresponding author

Correspondence to Nikitas Nanidis.

Additional information

Comment

This manuscript presents the making and use of a flow regulated external drain in 11 patients. To make this system, the authors utilised a device, the “dial-a-flow”, usually used to set and regulate a constant flow of IV infusion fluids. This idea is smart and interesting, as pressure-regulated CSF drainage requires much attention from the medical and nursing staff, plus a great deal of bed rest, besides the risk of over-drainage if the draining outlet is too low for any reason, which can happen anywhere, even in the best neurosurgical department. Although the group of patients in this study is small and heterogeneous, the results of the application of this methodology appear convincing to justify the improvement of the system with its adaptation to the particularities of CSF drainage. As the authors say, the ultimate validation of such a system must come from further clinical trials. A critical issue to investigate will be the obstruction rate. Such a system can prove particularly useful; firstly in conditions where CSF drainage is not vital, such as in the evaluation of shunting for NPH or for helping in the healing of CSF leaks. The system should, however, not be utilised or utilised with utmost caution in conditions where CSF drainage is required by ICP and is vital, as ICP pressure rises will not be buffered by such a flow-regulated system, at least as long as a safety pressure valve is not implemented in the system.

Shahan Momjian

Geneva, Switzerland

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Nanidis, N., Korfias, S. & Sakas, D.E. Flow-regulated external lumbar drain: applications and complications. Acta Neurochir 156, 2201–2205 (2014). https://doi.org/10.1007/s00701-014-2203-9

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  • DOI: https://doi.org/10.1007/s00701-014-2203-9

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