The Laryngoscope V C 2018 The American Laryngological, Rhinological and Otological Society, Inc. Continuous Lumbar Drainage and the Postoperative Complication Rate of Open Anterior Skull Base Surgery Barak Ringel, MD ; Narin N. Carmel-Neiderman, MD; Aviyah Peri, MD; Daniel Ben Ner, BScMed; Ahmad Safadi, MD; Avraham Abergel, MD; Nevo Margalit, MD; Dan M. Fliss, MD Objectives/Hypothesis: Anterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence-based data on its efficacy. The primary goal of this study was to review CNS complications following anterior open skull base surgery and their association with LD placement. The secondary goal was to define predictors for the development of early CNS complications. Study Design: Retrospective case series. Methods: We conducted a retrospective analysis of all patients who underwent anterior skull base surgery between 2000 and 2016 at the Tel Aviv Sourasky Medical Center, an Israeli tertiary referral center. Results: A total of 226 patients underwent open skull base surgery, of whom 118 had elective perioperative continuous LD insertion and 108 did not. Delayed complications were defined as those occurring more than 30 days after the index oper- ation. Thirty-one (26%) patients in the LD group had early CNS complications compared with only two (1.6%) in the non-LD group, whereas 13 (11%) of the former patients had late CNS complications compared with four (3%) of the latter patients. Early systemic and late wound complications were also significantly more numerous in the LD group. On multivariate analy- sis, elective LD insertion and intracranial tumor extension were found to be predictors for developing early CNS complications. Conclusions: The placement of continuous LDs might increase the risk of developing early and late CNS complications after open anterior skull base surgery. Key Words: Continuous lumbar drainage, skull base, complications. Level of Evidence: 4 Laryngoscope, 00:000–000, 2018 INTRODUCTION Refinements in surgical technique, accumulating knowledge, and changes in the paradigms of periopera- tive management of patients who undergo anterior skull base operations have not yet resolved the risk for postop- erative central nervous system (CNS) complications. 1–5 One of the questions that remains unanswered is whether the elective perioperative insertion of a continu- ous drainage catheter (LD) succeeds in fulfilling its objective of reducing postoperative CNS complications. The rationale for the insertion of continuous lumbar drainage is to induce dural decompression, facilitate frontal lobe manipulation, and reduce the risks of postoperative cerebrospinal fluid (CSF) leak and menin- gitis. However, continuous lumbar drainage itself may carry the potential risk of serious complications, such as tension pneumocephalus and meningitis. 6–9 Some surgeons insert LDs routinely after the induc- tion of general anesthesia, others place them solely for selected cases when CSF high flow leak is anticipated or if dural or intracranial involvement is detected postopera- tively, whereas others have abandoned the insertion of perioperative LDs altogether. Evidence-based data on the risk of complications following routine insertion of contin- uous LDs for open anterior skull base surgery are limited, and this issue remains a continuous source of controversy in the literature. The primary goal of this study was to review postoperative CNS, wound, and systemic complica- tions and their association with continuous LD placement in a large series of patients who underwent open anterior skull base surgery in a tertiary referral center. The secondary goal was to define independent risk factors for early postoperative CNS complications. MATERIALS AND METHODS We reviewed the medical records of all patients who were operated for skull base lesions at the Tel Aviv Sourasky Medical Center between 2000 and 2016. This study was approved by the institutional review board (IRB 0730-TLV-14), and patient con- sent was waived. A computer-assisted search of the institutional Additional Supporting Information may be found in the online version of this article. From the Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery (B.R., N.N.C.-N., A.P ., D.B., A.S., A.A., D.M.F .) and Department of Neurosurgery (N.M.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Editor’s Note: This Manuscript was accepted for publication April 11, 2018. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Dan M. Fliss, MD, Professor and Chairman, Department of Otolaryngology and Head and Neck Surgery and Maxillofa- cial Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 6423906, Israel. E-mail: danf@tlvmc.gov.il DOI: 10.1002/lary.27266 Laryngoscope 00: Month 2018 Ringel et al.: Lumbar Drainage in Open Skull Base Surgery 1