Effectiveness of Continuous Lumbar Drainage for CSF Leakage: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 XUHao , NIUChao-shi , DINGWan-hai , JIYing , JIANGXiao-feng , WANGLin , LIDong-xue

Department of Neurosurgery, Anhui Provincial Hospital, Hefei 230001, China;

Corresponding author：

Keywords：

CSF leakage; Lumbar drain; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20140178

Video：

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Objective To systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. Methods A comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results Seven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). Conclusion Current evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.

Citation： XUHao, NIUChao-shi, DINGWan-hai, JIYing, JIANGXiao-feng, WANGLin, LIDong-xue. Effectiveness of Continuous Lumbar Drainage for CSF Leakage: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(9): 1091-1096. doi: 10.7507/1672-2531.20140178 Copy

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3.	Deeks JJ, Dinnes J, D'Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):170-173.
4.	Caballero N, Bhalla V, Stankiewicz JA, et al. Effect of lumbar drain placement on recurrence of cerebrospinal rhinorrhea after endoscopic repair. Int Forum Allergy Rhinol, 2012, 2(3):222-226.
5.	Yeo NK, Cho GS, Kim CJ, et al. The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Acta Otolaryngol, 2013, 133(1):82-90.
6.	黄永华, 伍志德, 侯树勇.腰大池穿刺持续引流治疗难治性脑脊液漏.临床和实验医学杂志, 2007, 6(3):23-24.
7.	龚瑾, 蔡梅钦, 李文胜, 等.腰大池持续外引流治疗垂体瘤经蝶术后脑脊液漏.中国医师进修杂志, 2012, 35(32):58-60.
8.	董全永.腰大池持续外引流治疗垂体瘤经蝶术后脑脊液漏的临床疗效.中国医药指南2013, 11(28):180-109.
9.	于江龙, 兰世英.腰大池持续置管引流治疗脑脊液漏的临床疗效.新疆医科大学学报, 2012, 25(9):1224-1227.
10.	商崇智, 涂悦, 董化江, 等.早期腰大池引流术治疗急性颅脑创伤致外伤性脑脊液漏.新乡医学院学报, 2013, 30(5):371-375.
11.	Bardutzky J, Witsch J, Jüttler E, et al. EARLYDRAIN-outcome after early lumbar CSF-drainage in aneurysmal subarachnoid hemorrhage:study protocol for a randomized controlled trial. Trials, 2011, 12:203.
12.	Tuettenberg J, Czabanka M, Horn P, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. J Neurosurg, 2009, 110:1200-1208.
13.	Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair:is a lumbar drain necessary? Otolaryngol Head Neck Surg, 1999, 121:745-750.
14.	Mehta GU, Oldfield EH. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. J Neurosurg, 2012, 116(6):1299-1303.
15.	Allen KP, Isaacson B, Purcell P, et al. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol, 2011, 32(9):1522-1524.
16.	Becker SSl, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery:a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol, 2003, 24(1):107-112.
17.	Dalgic A, Okay HO, Gezici AR et al. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula:closed lumbar drainage system. Minim Invasive Neurosurg, 2008, 51(3):154-157.
18.	罗成义, 徐如祥.腰大池持续外引流治疗脑脊液漏的临床观察.中华神经医学杂志2005, 3(4):273-274.
19.	跃继, 苏晨芳.腰大池持续引流治疗伤口脑脊液漏.中华神经外科杂志, 2001, 17(3):161.
20.	Rnsom ER, Palmer JN, Kennedy DW. Assessing risk/benefit of lumbar drain use for endoscopic skullbase surgery. Int Forum Allergy Rhinol, 2011, 1:173-177.
21.	Kyle PA, Brandon I, Patricia P, et al. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol, 2011, 32(9):1522-2524.
22.	Aken MO, Feelders RA, de Marie S. Cerebrospinal fluid leakage during transsphenoidal surgery:postoperative external lumbar drainage reduces the risk for meningitis. Pituitary, 2004, 7(2):89-93.
23.	Viswanathan A, Whitehead WE, Luerssen TG, et al. Use of lumbar drainage of cerebrospinal fluid for brain relaxation in occipital lobe approaches in children:technical note. Surg Neurol, 2009, 71(6):681-684.

1. Abuabara A. Cerebrospinalfluid rhinorrhoea:diagnosis and management. Med Oral Patol Oral Cirbucal, 2007, 12:E397-400.
2. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
3. Deeks JJ, Dinnes J, D'Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):170-173.
4. Caballero N, Bhalla V, Stankiewicz JA, et al. Effect of lumbar drain placement on recurrence of cerebrospinal rhinorrhea after endoscopic repair. Int Forum Allergy Rhinol, 2012, 2(3):222-226.
5. Yeo NK, Cho GS, Kim CJ, et al. The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Acta Otolaryngol, 2013, 133(1):82-90.
6. 黄永华, 伍志德, 侯树勇.腰大池穿刺持续引流治疗难治性脑脊液漏.临床和实验医学杂志, 2007, 6(3):23-24.
7. 龚瑾, 蔡梅钦, 李文胜, 等.腰大池持续外引流治疗垂体瘤经蝶术后脑脊液漏.中国医师进修杂志, 2012, 35(32):58-60.
8. 董全永.腰大池持续外引流治疗垂体瘤经蝶术后脑脊液漏的临床疗效.中国医药指南2013, 11(28):180-109.
9. 于江龙, 兰世英.腰大池持续置管引流治疗脑脊液漏的临床疗效.新疆医科大学学报, 2012, 25(9):1224-1227.
10. 商崇智, 涂悦, 董化江, 等.早期腰大池引流术治疗急性颅脑创伤致外伤性脑脊液漏.新乡医学院学报, 2013, 30(5):371-375.
11. Bardutzky J, Witsch J, Jüttler E, et al. EARLYDRAIN-outcome after early lumbar CSF-drainage in aneurysmal subarachnoid hemorrhage:study protocol for a randomized controlled trial. Trials, 2011, 12:203.
12. Tuettenberg J, Czabanka M, Horn P, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. J Neurosurg, 2009, 110:1200-1208.
13. Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair:is a lumbar drain necessary? Otolaryngol Head Neck Surg, 1999, 121:745-750.
14. Mehta GU, Oldfield EH. Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas. J Neurosurg, 2012, 116(6):1299-1303.
15. Allen KP, Isaacson B, Purcell P, et al. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol, 2011, 32(9):1522-1524.
16. Becker SSl, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery:a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol, 2003, 24(1):107-112.
17. Dalgic A, Okay HO, Gezici AR et al. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula:closed lumbar drainage system. Minim Invasive Neurosurg, 2008, 51(3):154-157.
18. 罗成义, 徐如祥.腰大池持续外引流治疗脑脊液漏的临床观察.中华神经医学杂志2005, 3(4):273-274.
19. 跃继, 苏晨芳.腰大池持续引流治疗伤口脑脊液漏.中华神经外科杂志, 2001, 17(3):161.
20. Rnsom ER, Palmer JN, Kennedy DW. Assessing risk/benefit of lumbar drain use for endoscopic skullbase surgery. Int Forum Allergy Rhinol, 2011, 1:173-177.
21. Kyle PA, Brandon I, Patricia P, et al. Lumbar subarachnoid drainage in cerebrospinal fluid leaks after lateral skull base surgery. Otol Neurotol, 2011, 32(9):1522-2524.
22. Aken MO, Feelders RA, de Marie S. Cerebrospinal fluid leakage during transsphenoidal surgery:postoperative external lumbar drainage reduces the risk for meningitis. Pituitary, 2004, 7(2):89-93.
23. Viswanathan A, Whitehead WE, Luerssen TG, et al. Use of lumbar drainage of cerebrospinal fluid for brain relaxation in occipital lobe approaches in children:technical note. Surg Neurol, 2009, 71(6):681-684.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Continuous Lumbar Drainage for CSF Leakage: A Systematic Review

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