Silviu Albu1, Ioan S Florian2, Sorana D Bolboaca3. 1. Second Department of Otolaryngology, Romania. Electronic address: silviualbu63@gmail.com. 2. Department of Neurosurgery, Romania. 3. Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
Abstract
OBJECTIVE: In traumatic CSF leaks, the early lumbar drain (LD) placement could significantly shorten the rhinorrhea period. METHODS: Included were patients presenting CSF rhinorrhea subsequent to closed head trauma, admitted within 24h. Patients were randomly allocated into two treatment arms: 30 patients within Group A with CSF diversion via LD and 30 patients in Group B managed conservatively with bed rest and head elevation. Primary outcome was length of CSF rhinorrhea. Secondary outcomes were recurrent CSF leaks and meningitis occurrence. RESULTS: In Group A leak stopped within 10 days, in Group B leak persisted beyond 10 days in 2 patients. In Group A CSF leak time was 4.83±1.88 days while in Group B was 7.03±2.02 days. The difference is statistically significant: 2.2 days (95% CI 3.05-1.35), p<0.0001. During follow-up recurrent CSF leak developed in 7 patients (23%) in Group A and in 8 patients (27%) in Group B (p=0.63, not significant). Meningitis occurred in 3 patients in Group A (10%) and in 4 cases in Group B (13%) (p=0.61, not significant). CONCLUSIONS: The initial use of LDs in highly selected patients with traumatic CSF rhinorrhea resulted in a significant decrease of leakage. Nevertheless, the benefits should be carefully weighted with drawbacks.
RCT Entities:
OBJECTIVE: In traumatic CSF leaks, the early lumbar drain (LD) placement could significantly shorten the rhinorrhea period. METHODS: Included were patients presenting CSF rhinorrhea subsequent to closed head trauma, admitted within 24h. Patients were randomly allocated into two treatment arms: 30 patients within Group A with CSF diversion via LD and 30 patients in Group B managed conservatively with bed rest and head elevation. Primary outcome was length of CSF rhinorrhea. Secondary outcomes were recurrent CSF leaks and meningitis occurrence. RESULTS: In Group A leak stopped within 10 days, in Group B leak persisted beyond 10 days in 2 patients. In Group A CSF leak time was 4.83±1.88 days while in Group B was 7.03±2.02 days. The difference is statistically significant: 2.2 days (95% CI 3.05-1.35), p<0.0001. During follow-up recurrent CSF leak developed in 7 patients (23%) in Group A and in 8 patients (27%) in Group B (p=0.63, not significant). Meningitis occurred in 3 patients in Group A (10%) and in 4 cases in Group B (13%) (p=0.61, not significant). CONCLUSIONS: The initial use of LDs in highly selected patients with traumatic CSF rhinorrhea resulted in a significant decrease of leakage. Nevertheless, the benefits should be carefully weighted with drawbacks.
Authors: Yasir A Chowdhury; Andrew R Stevens; Wai C Soon; Emma Toman; Tonny Veenith; Ramesh Chelvarajah; Antonio Belli; David Davies Journal: Cureus Date: 2022-06-12
Authors: Shin Heon Lee; Chang-Min Ha; Sang Duk Hong; Jung Won Choi; Ho Jun Seol; Do-Hyun Nam; Jung-Il Lee; Doo-Sik Kong Journal: Front Oncol Date: 2022-05-04 Impact factor: 5.738