Efficacy And Risk Of Lumbar Drainage In Neurosurgery Department

Objective To obtain data of lumbar drainage (LD) of cerebrospinal fluid (CSF) and investigate the efficacy and risk of LD, including the rate, composition and time windows of LD complications, further to provide a possible guidance for prevention and treatment of LD complications, as well as clinical application to define the indications and contraindications of LD.Methods All charts of patients using LD in department of Neurosurgery, the First affiliated hospital, Zhejiang University, dated from January2011to December2013were retrospectively examined and data were screened by specific standards. And the number of drain kits and drain day by the time of onset for each complication were calculated. The relative information of patients who were then included were collected and univariate and multivariate analysis were made to investigate the risk factors.Results Two hundred and seventy-seven cases were screened and247cases were included in the study with30cases excluded. There were287kits used in the study population with multiple kits usage in38patients and treatment goal was achieved in 93.5%of these patients. Complications happened in30.0%of the patients and the total LD complication rate was40.1%, with multiple LD-related complications in17patients. Drain occlusion occurred in20.2%of patients, leakage in puncture site6.1%, intracranial infection4.5%, disconnection3.2%, local puncture site infection2.4%, headache from over drainage1.6%, herniation1.2%and drain shearing0.8%. No cranial nerve involvement, root irritation or hemorrhagic complications were observed. The duration of LD was8.0±4.2days. The drain day (DD) of the occurrence for drain occlusion was3.8±4.6DD, leakage in puncture site7.1±5.5DD, intracranial infection4.2±1.5DD, displacement5.8±4.7DD, local puncture site infection5.7±3.7DD, headache from over drainage4.0±4.2DD, herniation1.0±0.0DD and drain shearing6.0±1.4DD. All complications were observed between1-28DD. Univariate analysis and multivariate logistic analysis revealed that previous external drainage of CSF and previous intracranial infection are the risk factors (P<0.05).Conclusion Lumbar drainage is an effective method in neurosurgery department, while LD related complications varied in manifestations. Drain occlusion, leakage in the puncture site and intracranial infection are the most frequent complications and each complication has its own time window for occurrence. Previous CSF drainage and previous intracranial infection are the risk factors. Possible steps for prevention and treatment can be achieved by specific evaluation and adjustment for each complication.