ANA Discussion Forum

Pre-Treatment Options => Pre-Treatment Options => Topic started by: Sammict on May 09, 2008, 11:46:56 am

Title: Lumbar Drain
Post by: Sammict on May 09, 2008, 11:46:56 am
Hi Everyone

       One of the things my neurosurgon said he would placing a Lumbar Drain for the excess fluid. He said it would stay in for 3 days after surgery.

      He is a very good doctor he has done many AN Very Experienced but from everyones posts I am not reading to much about the Lumbar Drain so it's making a little nervous.

     Has anyone had one ? And I am hoping I am not awake when they do it I here it is very painful.

Sam
Title: Re: Lumbar Drain
Post by: ppearl214 on May 09, 2008, 12:06:31 pm
Hi Sam,

I, personally, don't know of anyone that had a "pre-planned" lumbar drain, but I do know of a user on this site (she's been rather quiet lately but do a search of her screennic and suggestion would be to send her a PM/email), Gennysmom, who did have a CSF leak and they  did (I believe) an 8 day lumbar drain when they discovered the CSF leak.   Off the top of my head, she comes to mind first.

Hope that helps.
Phyl
Title: Re: Lumbar Drain
Post by: Sammict on May 09, 2008, 12:34:40 pm
Phil

Thank you I will check it out.

 I am putting together a bunch of questions  for my doctors when I meet with them again on the 19th i can also find out more then.

I am just hoping it's something they do once they put me out I don't want to be awake for it.

Thanks Sam
Title: Re: Lumbar Drain
Post by: HeadCase2 on May 09, 2008, 01:48:01 pm
Sammict,
  I had a lumbar drain for a few days after AN surgery.  It was done sometime during surgery, in the lower back area, while I was "asleep", and did not hurt at all.  It was taken out either the day before or the day they let me out of the hospital.  I was aware that the lumbat drain was there, but it really didn't bother me as far as sleeping, or getting out of bed and walking around, etc.  I think the lumbar drain is there to make sure that cranial fluid pressure is low, allowing the skull intrusion area to heal up as fast as possible, which minimized possible infection of CSF (meningitis), and perhaps allowing for some swelling without cranial pressure going up.  Don't worry about a lumbar drain, it really won't bother you.
Regards,
  Rob
Title: Re: Lumbar Drain
Post by: Catflower on May 09, 2008, 02:23:43 pm
I also had a lumbar drain for a few days after my surgery.  It was placed during the time I was under anesthesia.  It didn't bother me at all.  The only thing that hurt was when the doctor took it out and put a couple of sutures in.

Linda in WV
Title: Re: Lumbar Drain
Post by: Sammict on May 09, 2008, 03:50:12 pm
Thank you so much for your responses I have been hearing hoarer stories about how they do it while your awake and how much it hurts.

I feel so much better.

Thanks soo much

Sam
Title: Re: Lumbar Drain
Post by: Jeanlea on May 09, 2008, 06:31:33 pm
Hi Sam,

I also had a lumbar drain for three days after my surgery.  It didn't bother me at all.  I only really know that I had it because my sister mentioned it.  No pain at all that I recall.  They must have put it in during the end of my surgery.

Jean
Title: Re: Lumbar Drain
Post by: leapyrtwins on May 09, 2008, 06:32:56 pm
Sam -

it's okay to ask the doctor to make sure the drain is put in after they put you out (anesthetize you, that is).  I didn't have a lumbar drain, but I did have a catheter - I think just about everybody does - due to the length of the surgery.  I asked my doctor to make sure the catheter was put in once I was asleep because I've had one placed while I was awake and it was no picnic.  He said it would be no problem and he was true to his word.

Jan
Title: Re: Lumbar Drain
Post by: Jeff on May 09, 2008, 07:05:14 pm
I also had a lumbar drain for a few days after my first surgery. And mine too was inserted while I was under anesthesia. My doctor said that they did this as a matter of course. I had a CSF leak after my second surgery and had to be readmitted. I had the drain inserted while I was awake and I agree that it does hurt. But, I would guess that you will get yours while under anesthesia. Best wishes on your surgery!
Jeff
Title: Re: Lumbar Drain
Post by: Sammict on May 12, 2008, 07:44:24 am
Thanks so much everyone I feel much better about it.

Thanks Again Sam
Title: Re: Lumbar Drain
Post by: leapyrtwins on May 12, 2008, 09:12:16 am
Sam -

just another note about this.  I've talked to two or three people within the past week who are scheduled for AN surgery soon and they tell me that some doctors are now inserting the lumbar drain during surgery as a "just in case".  So it appears it's becoming a natural addition to the surgical process.

That way if you need it, it's already in place and they don't have insert it post op while you are awake.  And if you don't need it, no harm done; they just remove it.

Jan
Title: Re: Lumbar Drain
Post by: Sammict on May 12, 2008, 01:24:58 pm
Hi Jan

My husband says he remembers the doctors telling us that they do put in as a percaution. I just never asked when they put it in.

 I started reading testimonials that they are typically done while your awake. So I got a little nervous.

But it sounds like I can request to have it done after I go under.


Thank you
Sam
Title: Re: Lumbar Drain
Post by: lori67 on May 12, 2008, 01:30:53 pm
Hi Sam.

I just spoke with a woman the other day who said she's having the lumbar drain put in at surgery time.  I've never heard of this, but it must be one of those things that some doctors to routinely, and others don't.  I'm sure they'll wait until you're under to do it as I'm sure they wouldn't intentionally inflict pain if it's not neccessary. 

Good luck to you.
Lori
Title: Re: Lumbar Drain
Post by: oHIo on May 17, 2008, 09:09:50 pm
I was told prior to surgery that I might have a lumbar drain (decision to be made by the neurosurgeon during surgery).  I did not wake up with one, but ended up with one for 6 days after my CSF leak.  They numbed the area, I believe they gave me some "happy" medicine and I don't remember feeling a thing.  I had been worried about it, but it was not a big deal.  The IV was more painful.


Title: Re: Lumbar Drain
Post by: Jim Scott on May 21, 2008, 12:01:11 pm
I never had a lumbar drain.  I didn't experience a CSF leak so I didn't need the drain.  My neurosurgeon told me that when he opened up my skull, CSF 'shot' out because it was under pressure from the AN (not much room in there).  However, putting one in during surgery doesn't seem like a bad idea and is certainly easier on the recovering patient.   Interesting new approach. 

Jim
Title: Re: Lumbar Drain
Post by: TP on May 21, 2008, 09:12:43 pm
I had my AN removed, few weeks later had major CSF leak from incision, had surgery, got menigitis ugh, then a few weeks later had another CSF leak went back into the hospital for a lumbar drain. Unfortunately I needed to have another CSF leak surgery two days later. My Dr apologized to me and said he probably should have given me a lumbar drain after my second surgery. The lumbar drain was a little uncomfortable while he inserted it in my lower back. I had it for about 8 days and then went home. I think your Dr is doing the right thing. I am sure your Dr has done a lot of research and maybe the trend is to do lumbar drains after these types of surgeries. I loved my Dr  and I believe he did everything he could to take care of me- I think my CSF leaks were due to my very hard head and small pee brain  ;D
Title: Re: Lumbar Drain
Post by: Sammict on May 22, 2008, 02:19:04 pm
Thanks everyone

I am hearing that it is becoming more of a normal procedure to put one in place during this type of surgery.

Thanks Sam
Title: Re: Lumbar Drain
Post by: jerseygirl on May 22, 2008, 02:27:02 pm
Sam,

I had my first AN surgery in 1988 and they put in a lumbar drain during the surgery. It was in the operating report and I was told a few times as well. It was a standard procedure back in those days but my understanding is it is actually becoming less common. The lumbar drain was removed when the surgery was over.

              Eve
Title: Re: Lumbar Drain
Post by: Jim Scott on May 24, 2008, 04:15:25 pm
Prior to my surgery, I asked my neurosurgeon about the possibility of a CSF leak.  He stated that he hadn't had a CSF leak 'in years'  He used the titanium mesh instead of belly fat, which may be why - or, he just does very neat work.  I think it could be a bit of both.  :)  I'm pleased to report that I had no CSF leaks.

I suspect that because of growing experience and using the titanium mesh, CSF leaks associated with AN surgery are getting rarer and the lumbar drain less necessary.  However, as nothing can be guaranteed, putting one in during the surgery is not illogical and does save the patient future discomfort should a drain later be required.  Hopefully, that requirement will become less common in the coming years.

Jim   
Title: Re: Lumbar Drain
Post by: leapyrtwins on May 25, 2008, 07:04:35 am
He used the titanium mesh instead of belly fat, which may be why - or, he just does very neat work.  I think it could be a bit of both.

Jim -

I had the belly fat and a titanium plate & titanium screws for my AN surgery - and no CSF leak for me.

I just assumed that sometimes CSF leaks happen and sometimes they don't - regardless of the surgeon and his work; kind of like lots of other AN surgery side effects.

But now you've got my curiosity.  How does titanium mesh and "neat work" cut down on CSF leaks  ???

Jan
Title: Re: Lumbar Drain
Post by: lori67 on May 27, 2008, 12:32:09 pm
Jan, maybe he put some spackle over the mesh?   ;D

I didn't have a leak either, but I'm sure they were able to get enough excess fat from elsewhere to be sure nothing will ever leak through!

Lori
Title: Re: Lumbar Drain
Post by: leapyrtwins on May 27, 2008, 02:03:41 pm
Jan, maybe he put some spackle over the mesh?   ;D


Maybe.  It seems like he's got a huge tool box - drills, screwdrivers, torque wrenches, etc.  I wouldn't be a bit surprised if he had spackle also  ;)

From a medical professional's perspective (that's you, Lori) is there any weight to Jim's theory of titanium mesh and/or neat work?  Does this make a difference between having a CSF leak or not?  I wonder what Sam Rush would say?

Just curious,

Jan
Title: Re: Lumbar Drain
Post by: 4cm in Pacific Northwest on May 27, 2008, 02:38:36 pm
I had the belly fat , the titanium mesh … and later also had CSF leaks.  ???I interviewed 9 surgeons and only one said that he always does a lumbar drain as a precautionary measure. HEI however did not think this was necessary and mentioned it can lead to other complications by having another access point to spinal fluid. They said they “ifâ€? there was a need then later a lumbar can be placed in.

I ended up with inflammation and leaks. WHO KNOWS…maybe   :-\ we should have done a lumbar drain before the surgery- hard to say… However know mine healed on its own, without a shunt, and I never had an infection.  :)

The key is to ask your surgeon what his infection rate is.

RE quoting  Lori,

“maybe he put some spackle over the mesh?â€? 

Actually some surgeons do this- it is called “calcium phosphate cement pasteâ€?. Other surgeons feel that it increases the chance of infection and are very opposed to this. My neurosurgeon did not to do this and consequently I can very much feel my big indentation below the skin.  :-\  (BTW my tumor was 4cm)

I brought the “lumbar drainâ€? and the “spackleâ€? issue up and got different answers form each different surgeon I interviewed.  :-\

I know of one person, on this forum, that went with one of the surgeons, I personally interviewed and later crossed off my list  :-X , and he DID seal her with the calcium phosphate cement. I asked him what his infection rate was and he basically indicated it was “almost nilâ€?. Later she and I connected and communicated after my surgery. She informed me she actually suffered from meningitis after a shunt was later put in (to deal with CSF leaks) …and she now complains of cognitive issues. (Does that make her one of the “nillâ€? stats being that she had her surgery before I interviewed him?!? Our AN world is small and eventually us patients do get to talk to each other… I am wondering how much honest infection rate reporting took place-in her case.)

I am thinking:
a) that the calcium phosphate may have introduced the bacteria to her CSF
b) she would not have needed a shunt if a lumbar drain was in place  :-\ (I am not a surgeon - so not sure)
c) the cognitive issues are not from an AN but more likely from the meningitis she got as a complication of the CSF leak (I.e. inflammation of the brain)

This is a very valid question to ask?

Again-Know that my leaks cleared up on its own without a shunt. Meanwhile as I was experiencing periodic leaks at home- I was taking my temp, ever hour, ready to fly into emergency at the 1st sign of meningitis. It was a stressful and tense time- expspecially since I live out in the country and not in the same state where my surgeon practiced -when this was all happening.   :o ::) ::) I never got an infection! (9 Months later I am doing fine- here  :) 8) )

Patients also need to be aware that meningitis can also enter in through a lumbar drain… but also know that to treat meningitis a lumbar drain is put in… to alleviate any inflammation to the brain.

From my experience the lumbar drain is still a much debated issues within the AN medical community (it was right up there with T/L vs R/S for large tumors and facial nerve preservation  ::) ::) )

Daisy Head Mazy


PS
Some people do not want to know all of this information as it is overwhelming. I was one who wanted to know all I could- thus I interviewed so many world renown surgeons and specifically asked about the “lumbar drain� and “the skull spackle�

Here is more information “IF� you care to know

Meningitis
http://en.wikipedia.org/wiki/Meningitis

calcium phosphate cement – article that mentions infection
http://linkinghub.elsevier.com/retrieve/pii/S0278239104012662
(my understanding is that this is still under research- re infection rate)

Risks with the lumbar drain
http://uscneurosurgery.com/infonet/surgery/understand/risks/procedure/lumbar%20drain.htm
&
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1736582
quote
 Ã¢â‚¬Å“CONCLUSIONS—External lumbar drainage seems to carry a low risk of infectious meningitis and offers a safe alternative to ventriculostomy or serial lumbar punctures. Antibiotics do not seem to protect completely against developing the infection. The infection happens most often with skin organisms. The meningitis often appears within 24 hours after lumbar drain placement. Daily CSF samples should include bacterial cultures but cell counts may not offer any additional useful information in diagnosing the complication. Lumbar drain insertion and management need not be confined to the intensive care unit.â€?
Title: Re: Lumbar Drain
Post by: leapyrtwins on May 27, 2008, 10:23:42 pm
4 -

thanks for the info on the "spackle".

I think Lori was just joking around with me  ;)

Who knew there was such a thing  ::)

Jan
Title: Re: Lumbar Drain
Post by: Captain Deb on May 28, 2008, 05:00:29 pm
"Skullspackle!" Another one for the AN dictionary!

Don't worry Sam, there is no question you can't ask here.  Feel free.

Capt Deb 8)
Title: Re: Lumbar Drain
Post by: Sammict on May 29, 2008, 09:35:56 am
WOW much information to take in about Lumbar drains. I am a bit nervous because i have had migranes since I was 3 yrs old.

I feel confident my doctors are in steering me in the right direction. They were honest with me that my migranes will most likely increase after surgery. I guess thats a stone I will turn if the time comes.

Thanks for all the info.

Sam
Title: Re: Lumbar Drain
Post by: Jim Scott on June 01, 2008, 01:50:35 pm
Jan:

I never asked my neurosurgeon, the sainted Dr. Issac Goodrich, why his AN surgical patients didn't have CSF leaks, only if his AN surgical patients had them.  His answer was that he hadn't had a CSF leak in an Acoustic Neuroma surgical patient in ( all together now)"years".  He went on to explain (in his usual, helpful manner) that he used the titanium mesh to seal the incision site and that it had proved "very effective".  I simply speculated that, because I had so few complications and Dr. Goodrich is known (and highly esteemed) for being a very cautious and careful surgeon, that he was very meticulous.  The fact that other surgical patients have had CSF leaks with the surgeon using the same kind of material to close the incision presumably validates my (admitted) guess that some surgeons do slightly more precise handiwork than others.  In this kind of demanding neurosurgery, we're talking about tiny gradations of surgical skill, not anything major or even very conspicuous. 

I'm very grateful that I didn't experience a post-op CSF leak but installing a lumbar drain during surgery still seems like a reasonable idea.  However, I can why some surgeons might consider installing the drain during surgery as tacitly admitting that the patient will have a CSF leak, which (they might assume) would make them appear as less than fully competent.   If so, perception would trump caution, but again, I'm simply speculating.  I have no idea what any particular neurosurgeon might be thinking about installing a lumbar drain during surgery, before a CSF leak is indicated.  It's probably just a technical decision, based on their personal experience 

I will state, unequivocally, that not every surgeon is equal in skill and knowledge.  I was very fortunate to have one that is highly skilled and experienced.  No wonder he's been an ANA member for many years.  :)

Jim
Title: Re: Lumbar Drain
Post by: leapyrtwins on June 01, 2008, 01:58:11 pm

I will state, unequivocally, that not every surgeon is equal in skill and knowledge.  I was very fortunate to have one that is highly skilled and experienced. 

Jim -

I totally agree with this.  I too was fortunate to have highly skilled and experienced doctors.  I'm grateful for them each and every day  :)

Thanks for your thoughts on the CSF leaks and titanium mesh.  If I think of it on Wednesday when I get my BAHA processor, I'm going to ask my doc if he feels titanium mesh and neat work make for less CSF leaks.   I'm not really looking for a scientific answer here; I'm just curious to find out his opinion.

Jan
Title: Re: Lumbar Drain
Post by: lori67 on June 02, 2008, 02:18:10 pm
I would venture to say that all surgeons say they perform "neat work".  Except maybe orthopedists, who generally feel it doesn't matter what it looks like, as long as it works!

I guess a leak is just one of those things... some people get AN's - some people don't.  Some people get leaky heads - some people don't.  Maybe those of us that are normally more thickheaded don't get them as often?

Jan, sorry I didn't get back to your spackle question...had to fly out of town unexpectedly last Tuesday to be with my Dad, who passed away on Wednesday.  Still trying to catch up on what I missed around here while I was away.  I did briefly see something about Jim in a coconut bra....  ???

Lori
Title: Re: Lumbar Drain
Post by: leapyrtwins on June 02, 2008, 07:11:53 pm
Lori -

I'm so sorry to hear about your dad - very sad news  :(

It seems that in your absence Jim decided to take a cruise on the PBW - he's the 2nd moderator in attendance - no word on Joef or Steve (unless I just missed their presence).

I, too, believe that CSF leaks happen for some, don't for others - but it's just my gut reaction; no medical studies to back me up that I'm aware of  ::)

Don't know if my doc will say he does "neat work" or not - worth asking him though.  If nothing else, he'll be amused by the question.  But then again, I always amuse him  :D

Jan
Title: Re: Lumbar Drain
Post by: sgerrard on June 02, 2008, 09:20:49 pm
It seems that in your absence Jim decided to take a cruise on the PBW - he's the 2nd moderator in attendance - no word on Joef or Steve (unless I just missed their presence).

fade in from the mist...Joe, I think the disguises are working...fade away into the mist
Title: Re: Lumbar Drain
Post by: Tamara on July 10, 2008, 08:01:58 pm
Hey- I just found this thread.  I had the lumbar drain inserted while I was under for surgery, and had it for 2 days afterwards.  I also had prophylactic antibiotics administered beginning right before surgery and continuing for 24 hours (the correct protocol if you look it up).  I did NOT get meningitis.  I did fine until 8 days after surgery, when I developed a CSF leak through my incision.  Back to the OR for more stitches, staples, and glue (hopefully to be removed tomorrow).  Also was put on oral antibiotics.  I was also told that this was "almost unheard-of", but that in some people, the body's response to the stress of surgery is to produce more CSF.  So THAT might be the explanation as to why some of us get a leak, regardless.

Sam's probably a postie by now, so I don't know if this info is even useful, or relevant, but there it is...
Tammy
Title: Re: Lumbar Drain
Post by: Sammict on July 11, 2008, 02:45:32 pm
Hi Tamara

I'm not a postie yet I had some complication and my surgery has been postponed until the fall. I was told that the Lumbar drain was to help prevent CSF leaks i'm sorry to hear that you had to go back in. Thank you for the update I was hoping that they insert while I'm under I have heard it is painfuill if they don't. My doctor did tell me every doctor is different but he does his during surgery so I was relieved.

Thanks for the feedback

Sam
Title: Re: Lumbar Drain
Post by: TP on July 14, 2008, 03:12:58 pm
I had a lumbar drain put in several weeks AFTER my AN was removed. It did not hurt at all, just a little uncomfortable during the process which only took a few minutes and done in my hospital bed. Once inserted you stay in bed for the most part.
Title: Re: Lumbar Drain
Post by: ColoradoGal on July 15, 2008, 11:43:02 am
Based on my research - It is standard practice to put in drains at Barrows Neurological Institute for surgery.  My understanding is that they think there are benefits during surgery (relieving spinal fluid pressure and allowing the cerebellum to fall back more) and it also helps post surgery.
Title: Re: Lumbar Drain
Post by: MAlegant on July 19, 2008, 05:51:27 pm
My surgeon told me that they will do a lumbar drain (he trained at Barrows) and that it is to prevent pressure from building up in the brain after surgery.  I said "I do music, you do medicine, do what you need to do." By that point I had already been told by a surgeon at the Cleveland Clinic that they would do that as well. At least here in Cleveland it seems to be common practice.
Marci