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Tunneled lumbar drain

Technical note

Michael Hahn, Raj Murali and William T. Couldwell

T reatment to prevent a CSF fistula commonly involves the use of continuous lumbar drainage. 1–3, 6 For longer term drainage, it may be desirable to tunnel the catheter laterally to avoid kinking of or leakage around the tube at the skin exit site. We report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic closed CSF drainage. We have found this method to be particularly useful in some skull base and spinal surgical applications in which continuous drainage is desired. Surgical Procedure The patient is

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Menachem M. Gold, Todd S. Miller, Joaquim M. Farinhas, David J. Altschul, Jacqueline A. Bello and Allan L. Brook

C erebrospinal fluid lumbar spinal drainage is useful for lowering CSF pressure, achieving brain relaxation during intracranial surgery, and preventing and/or treating intracranial and spinal CSF fistulas. Various techniques for establishing lumbar spinal drainage have been employed and its safety and efficacy are well documented.1–5 Occasionally, standard attempts at intraoperative or bedside lumbar drain placement fail, especially in obese patients, patients who have undergone prior lumbar surgery, patients who are difficult to position, or patients with

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Kern H. Guppy, James W. Silverthorn and Paul T. Akins

I ntrathecal lumbar spinal catheters (lumbar drains) have been used for either the drainage of CSF or the delivery of drugs. The former use is common in neurosurgery to reduce intracranial pressure and allow brain retraction, as in the surgical clipping of aneurysms 5 or the removal of brain tumors. Recently these drains have been extensively used to provide spinal cord protection by increasing spinal cord perfusion during thoracoabdominal aortic aneurysm repair. 4 , 6 , 7 The placement-related complication rate associated with lumbar intrathecal

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Neurosurgical Forum: Letters to the Editor To The Editor Satoru Shimizu , M.D. Kitasato University School of Medicine Sagamihara, Japan 442 443 Abstract The authors report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic cerebrospinal fluid (CSF) drainage. A standard lumbar puncture (LP) is performed with a large-bore Tuohy needle (14- to 16-gauge), the drainage catheter is advanced into the subarachnoid space, and the needle is removed. The free Tuohy needle is

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Ariane Lewis, Aaron Rothstein and Donato Pacione

L umbar drain placement is a common neurosurgical procedure to facilitate cerebrospinal fluid (CSF) drainage. 24 There is a 3%–12% risk of surgical site infection (SSI) after placement of a lumbar drain. SSI can increase morbidity and mortality. 10 , 15 , 24 Few studies address infection prevention for patients with lumbar drains, but extrapolating from the literature on patients with external ventricular drains, 2 strategies to avoid SSI are 1) the use of prolonged prophylactic systemic antibiotics (PPSA) until the time of drain removal and 2) daily CSF

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Nickalus R. Khan, Zachary Smalley, Cody L. Nesvick, Siang Liao Lee and L. Madison Michael II

and paraparesis?” Search Strategy The systematic search strategy involved a search through multiple electronic databases, bibliographies of relevant articles, and consultation with the senior author (L.M.M.). We electronically searched , The Cochrane Library, PubMed/MEDLINE, and Scopus to find English-language articles—excluding gray literature—with no timeframe restrictions in August of 2015. The following terms in various combinations were used: aortic aneurysm, cerebrospinal fluid, endovascular, lumbar drain, paraplegia, paraparesis

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Martin Jakobs, Sabrina Klein, Tatjana Eigenbrod, Andreas W. Unterberg and Oliver W. Sakowitz

T emporary diversion of cerebrospinal fluid (CSF) is a common neurosurgical therapy for a variety of different diseases and states. Typically, CSF is either drained from the ventricles via an external ventricular drain (EVD), especially in cases of occlusive hydrocephalus, or drained from the thecal space via an external lumbar drain (ELD), particularly in cases of communicating hydrocephalus, CSF fistulas after trauma or surgery, or as a diagnostic test in patients with normal pressure hydrocephalus (NPH) 3 , 6 , 17 Although the procedures of placing EVDs and

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Tarek Y. El Ahmadieh, Eva M. Wu, Benjamin Kafka, James P. Caruso, Om J. Neeley, Aaron Plitt, Salah G. Aoun, Daiwai M. Olson, Robert A. Ruchinskas, C. Munro Cullum, Samuel Barnett, Babu G. Welch, H. Hunt Batjer and Jonathan A. White

. The CSF tap test (CSF-TT) (up to 50 ml of CSF is removed through a lumbar puncture), 42 lumbar drain (LD) trial (CSF is removed continuously over 4 days), 41 and lumbar infusion (infusion of normal saline through a lumbar puncture cannula) 11 , 19 have been used as diagnostic tools to support the diagnosis of NPH and to serve as predictors of response to ventriculoperitoneal shunting (VPS). 8 Many studies have found that prolonged external lumbar drainage (ELD) of greater than 300 ml has a higher sensitivity and positive predictive value than a CSF-TT 35 or high

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Maurine A. Leverstein-van Hall, Titia E. M. Hopmans, Jan Willem Berkelbach van der Sprenkel, Hetty E. M. Blok, Wil A. M. A. van der Mark, Patrick W. Hanlo and Marc J. M. Bonten

: Bacterial meningitis associated with lumbar drains: a retrospective cohort study . J Neurol Neurosurg Psychiatry 67 : 468 – 473 , 1999 5 Garner JS , Jarvis WR , Emori TG , Horan TC , Hughes JM : CDC definitions for nosocomial infections, 1988 . Am J Infect Control 16 : 128 – 140 , 1988 6 Holloway KL , Barnes T , Choi S , Bullock R , Marshall LF , Eisenberg HM , : Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients . J Neurosurg 85 : 419 – 424 , 1996 7 Hopmans TEM , Blok

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Edward R. Laws Jr., Kenneth de los Reyes and Jordina Rincon-Torroella

report no conflict of interest. References 1 Mehta GU , Oldfield EH : Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. Clinical article . J Neurosurg 116 : 1299 – 1303 , 2012 2 Ransom ER , Palmer JN , Kennedy DW , Chiu AG : Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery . Int Forum Allergy Rhinol 1 : 173 – 177 , 2011