The benefit of early lumbar drain insertion in reducing the length of CSF leak in traumatic rhinorrhea.

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.