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

• Prospective, randomized study.
• Included closed head trauma CSF rhinorrhea patients.
• Lumbar drains (LD) were compared to conservative treatment.
• In selected patients LDs resulted in significant decrease of CSF leakage.
• Benefits should be weighted with drawbacks.

ObjectiveIn traumatic CSF leaks, the early lumbar drain (LD) placement could significantly shorten the rhinorrhea period.MethodsIncluded were patients presenting CSF rhinorrhea subsequent to closed head trauma, admitted within 24 h. 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.ResultsIn 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).ConclusionsThe 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.