Comparison of Duration of Cerebrospinal (CSF) Leak in Post-Traumatic Patients Managed by Early Lumbar Drain vs Conservative Treatment

Abstract

Objective To compare the duration (days) of CSF leak among post traumatic patients managed by early lumbar drain (LD) vs conservative treatment.

Methodology: Department of Neurosurgery, Rawalpindi Medical University, Rawalpindi from 23st October, 2023 to 23rd April, 2024, where patients presented with post traumatic or post-surgical CSF leakage from emergency or OPD were included in the study. Patients will be randomly divided into two group. In Group A LD (lumbar drain) was inserted and in Group B patients were treated conservatively. After 10 days of CSF drainage, if CSF leak continues, LDs were removed and conservative treatment stopped and surgical repair was performed. Patient data was collected on a predesignated proforma.

Results Total 60 patients Data was entered and analyzed using SPSS 21.0 Patients were randomly divided into two group. In Group A LD (lumbar drain) was inserted and in Group B patients were treated conservatively. Randomization was carried out with a computer-generated number. Mean age (years) was 37.30+11.76 with 50 (83.3%) male and 10 (16.7%) female patients. Frequency of CSF leakage cessation in lumbar drain vs conservative group was 29 (96.7%) vs 21 (70.0%) respectively.  Mean duration (days) of CSF leakage cessation among lumbar drain vs conservative group was 5.23+1.67 vs 6.40+1.35 respectively (p<0.05).

Conclusion The study concluded that Early Lumbar drain placement is better than conservative treatment for CSF leak in terms of duration (in days). By providing CSF an alternative route for drainage, the fistula site will remain dry. Leakage site won’t be facing CSF pressure and this will promote early healing of the wound.