Interdisciplinary Neurosurgery (Mar 2021)
Efficacy of lumbar spinal drainage for straightforward approach in reoperation via lateral suboccipital retrosigmoid craniotomy
Abstract
Background: Much effort is required to dissect the adhesion in the surgical trajectory in reoperation via the lateral suboccipital retrosigmoid approach. Lumbar drainage is a standard procedure in neurosurgical practice; its usefulness during reoperation has not been reported. The purpose of this study is to elucidate whether pretreatment with lumbar drainage is effective in enabling a more straightforward lateral suboccipital approach during reoperation. Methods: There were 13 reoperations among 115 lateral suboccipital craniotomies performed by a single surgeon between April 2016 and March 2018 at our institution. Lumbar drainage was performed prior to reoperations when tight adhesion was anticipated by preoperative neuroimaging. We retrospectively inspected 11 reoperations in which the video recordings were available. Results: After lumber drainage, the cerebellum was slack by the start of the dural incision. The total approach time, defined as the time between starting dural incision and reaching the cerebellopontine cistern, in the group with lumbar drainage (47 min. 45 sec., n = 6) was 13 min. 46 sec. shorter than that of the group without drainage (61 min. 31 sec., n = 5) (p = 0.09). The number of times hemostasis was required in the group with drainage (4 ± 1.4) was significantly lower than that of the group without drainage (7 ± 1.4) (p < 0.01). Conclusions: Lumbar drainage assisted in a smooth and safe dissection of the surgical trajectory for the reoperation via lateral suboccipital retrosigmoid craniotomy. Our results suggest a usefulness of lumbar drainage prior to reoperation.
