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

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.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Liang B,Shetty SR,Omay SB,Almeida JP,Ni S,Chen YN,Ruiz-Treviño AS,Anand VK,Schwartz TH

doi

10.1007/s00701-017-3247-4

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

1379-1385

issue

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-017-3247-4

journal_volume

159

pub_type

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