{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:45:42Z","timestamp":1783773942753,"version":"3.55.0"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,10,3]],"date-time":"2016-10-03T00:00:00Z","timestamp":1475452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well\u2010established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta\u2010analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Method<\/jats:title><jats:p>A meta\u2010analysis was performed according to PRISMA guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1314\u00a0nonduplicate studies were identified in our search. Twelve articles comprising 508 cases met inclusion criteria. Overall, use of LDs was not associated with significantly lower postoperative CSF leak recurrence rates following endoscopic repair of CSF rhinorrhea (odds ratio: 0.89, 95% confidence interval: 0.40\u20101.95) as compared with cases performed without LDs. Subgroup analysis of only CSF leaks associated with anterior skull base resections (6 studies, 153 cases) also demonstrated that lumbar drainage did not significantly affect rates of successful repair (odds ratio: 2.67, 95% confidence interval: 0.64\u201011.10).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is insufficient evidence to support that adjunctive lumbar drainage significantly reduces postoperative CSF leak recurrence in patients undergoing endoscopic CSF leak repair. Subgroup analysis examining only those patients whose CSF leaks were associated with anterior skull base resections demonstrated similar results. More level 1 and 2 studies are needed to further investigate the efficacy of LDs, particularly in the setting of patients at high risk for CSF leak recurrence.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599816670370","type":"journal-article","created":{"date-parts":[[2016,9,27]],"date-time":"2016-09-27T21:48:59Z","timestamp":1475012939000},"page":"52-60","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Efficacy of Perioperative Lumbar Drainage following Endonasal Endoscopic Cerebrospinal Fluid Leak Repair: A Meta\u2010analysis"],"prefix":"10.1002","volume":"156","author":[{"given":"Omar H.","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery New York University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Marcus","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery New York University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna R.","family":"Tauber","sequence":"additional","affiliation":[{"name":"School of Medicine New York University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binhuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population Health Division of Biostatistics New York University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Mathematical Sciences New Jersey Institute of Technology Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Lebowitz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery New York University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688699008992759"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200007000-00019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0709(03)00031-0"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812451090"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2000.107452"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065801781329356"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20026"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1253573"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21040"},{"key":"e_1_2_8_11_1","first-page":"78","article-title":"The utility of lumbar drains in modern endoscopic skull base surgery","volume":"23","author":"Stokken J","year":"2015","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/hn.1999.v121.a98754"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001665-199211000-00006"},{"key":"e_1_2_8_14_1","first-page":"597","article-title":"Endoscopic transnasal cerebrospinal fluid leak repair: a 10 year experience","volume":"13","author":"Gilat H","year":"2011","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"e_1_2_8_16_1","unstructured":"Oxford Centre for Evidence\u2010Based Medicine. The Oxford2011levels of evidence.http:\/\/www.cebm.net\/index.aspx?o=5653. Accessed March 5 2016."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24448"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23291"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2015.04.002"},{"key":"e_1_2_8_20_1","unstructured":"HigginsJPT GreenS.Cochrane handbook for systematic reviews of interventions version 5.1.0.http:\/\/handbook.cochrane.org. UpdatedMarch 2011."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2013.27.3986"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21023"},{"key":"e_1_2_8_25_1","first-page":"150","article-title":"Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances","volume":"67","author":"Fraser JF","year":"2010","journal-title":"Neurosurgery"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2011.08.034"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200408000-00029"},{"key":"e_1_2_8_28_1","article-title":"\u201cGasket\u2010seal\u201d watertight closure in minimal\u2010access endoscopic cranial base surgery","volume":"62","author":"Leng LZ","year":"2008","journal-title":"Neurosurgery"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2006.20.2931"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065898780707900"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.3105"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3378"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000234933.37779.e4"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21627"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2015.09.007"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-970556"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215115000584"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199609000-00007"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200301000-00025"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21089"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100136643"},{"key":"e_1_2_8_42_1","first-page":"201","article-title":"Transnasal endoscopic treatment of cerebrospinal fluid leaks: 10 years\u2019 experience","volume":"9","author":"Oles K","year":"2013","journal-title":"B\u2010ENT"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2015.58.1.36"},{"key":"e_1_2_8_44_1","first-page":"191","article-title":"Transnasal endoscopic treatment of cerebrospinal fluid leak: 17 years\u2019 experience","volume":"29","author":"Presutti L","year":"2009","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-932188"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-010-0006-3"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3150"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816670370","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599816670370","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816670370","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:35:14Z","timestamp":1760956514000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599816670370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,3]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["10.1177\/0194599816670370"],"URL":"https:\/\/doi.org\/10.1177\/0194599816670370","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,3]]},"assertion":[{"value":"2016-06-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}