External Lumbar Drain in Skull Base Surgery: The Great Help We Rarely Talk About
In transcranial skull base surgery we work underneath the brain, and when the cisterns are not accessible, space is gained by retraction. A recent series of elective aneurysm clipping found retraction injury on CT in 46% of patients.
The external lumbar drain relaxes the brain before the dura is opened: 10 to 20 ml drained in a controlled way gain space with less retraction. In endoscopic surgery it is one of the few tools supported by a randomized trial, which reduced CSF leak from 21% to 8% in high-flow defects.
In this article I review the evidence without bias: where it helps, where it is not needed, its risks and how to reduce them, and its real clinical value.
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