2015.03.07, Abstract as Submitted
2
General Information Scientific Content Experience with a Novel, Automated, External Cerebrospinal Fluid Drainage Control Device - Submitted: 3/7/2015 Abstract Title: Experience with a Novel, Automated, External Cerebrospinal Fluid Drainage Control Device Study Design: Clinical Trial Preferred Format: Any Format Subject Category: Socioeconomic/CSNS Award Consideration: Samuel Hassenbusch Young Neurosurgeon Award (Socioeconomic) Introduction: Most available lumbar drainage systems are functionally identical to the first gravity-fed device described in 1963. Although lumbar drainage is the standard of care for a variety of pathologies, complication rates are high, up to 40% in some series. Additionally, manually controlled lumbar drains are labor intensive and therefore costly. Gravity-independent, pump-regulated systems have been proposed, but adoption was limited by the risks associated with active CSF removal. We propose the use of a new gravity-fed system that is microprocessor controlled, programmable, and prevents over- or under-drainage. It should improve patient safety and lower treatment costs. Methods: Thirty-five consecutive patients requiring external lumbar drainage were treated using the FlowSafeTM system (BeckerSmith Medical, Irvine, CA). Results: Nineteen men and 16 women, average age 42.6 years, were drained for a mean of 93 hours (range 24 to 144). Drainage rates averaged 8.0 ml/hour (range 5 to 15). A single dose of antibiotics was used in 24 patients. Eleven received antibiotics for 48 to 144 hours. Diagnoses included skull base surgery (18), spontaneous and traumatic CSF fistulas (7), unintentional durotomy (7), normal pressure hydrocephalus (2), and intracranial hypertension due to meningitis (1). Set up times were minimal. Manual interventions, to regulate flow, were not required. There were no mechanical failures. Two individuals (6%) reported headache. Drainage was temporarily discontinued in one and the rate was decreased in the other. In both, headaches resolved promptly. No other complications were observed. Conclusions: The system proved convenient, safe and effective. Our complication rate was lower than in published series for current manual systems. Manual interventions were not required. With this system, ICU level care will not be necessary for many patients. Larger trials are needed, and the efficacy should be evaluated in patients with other diagnoses, including those undergoing aortic surgery.
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Transcript of 2015.03.07, Abstract as Submitted
General Information
Scientific Content
Experience with a Novel, Automated, External Cerebrospinal Fluid Drainage Control
Device - Submitted: 3/7/2015
Abstract Title: Experience with a Novel, Automated, External Cerebrospinal Fluid
Drainage Control Device
Study Design: Clinical Trial
Preferred Format: Any Format
Subject Category: Socioeconomic/CSNS
Award Consideration: Samuel Hassenbusch Young Neurosurgeon Award
(Socioeconomic)
Introduction: Most available lumbar drainage systems are functionally identical
to the first gravity-fed device described in 1963. Although lumbar
drainage is the standard of care for a variety of pathologies,
complication rates are high, up to 40% in some series.
Additionally, manually controlled lumbar drains are labor intensive
and therefore costly. Gravity-independent, pump-regulated
systems have been proposed, but adoption was limited by the
risks associated with active CSF removal. We propose the use of a
new gravity-fed system that is microprocessor controlled,
programmable, and prevents over- or under-drainage. It should
improve patient safety and lower treatment costs.
Methods: Thirty-five consecutive patients requiring external lumbar drainage
were treated using the FlowSafeTM system (BeckerSmith Medical,
Irvine, CA).
Results: Nineteen men and 16 women, average age 42.6 years, were
drained for a mean of 93 hours (range 24 to 144). Drainage rates
averaged 8.0 ml/hour (range 5 to 15). A single dose of antibiotics
was used in 24 patients. Eleven received antibiotics for 48 to 144
hours. Diagnoses included skull base surgery (18), spontaneous
and traumatic CSF fistulas (7), unintentional durotomy (7), normal
pressure hydrocephalus (2), and intracranial hypertension due to
meningitis (1). Set up times were minimal. Manual interventions,
to regulate flow, were not required. There were no mechanical
failures. Two individuals (6%) reported headache. Drainage was
temporarily discontinued in one and the rate was decreased in the
other. In both, headaches resolved promptly. No other
complications were observed.
Conclusions: The system proved convenient, safe and effective. Our
complication rate was lower than in published series for current
manual systems. Manual interventions were not required. With
this system, ICU level care will not be necessary for many patients.
Larger trials are needed, and the efficacy should be evaluated in
patients with other diagnoses, including those undergoing aortic
surgery.
Attachments:
Authors:
Learning Objectives: By the conclusion of this session, participants should be able to:
(1) describe the available CSF drainage systems; (2) discuss the
indications for, efficacy of, and safety of cerebrospinal drainage;
and (3) describe the cost-savings achieved with automated
systems.
Keywords: Cerebrospinal Fluid, Dural Tear, Lumbar Drain, Skull Base Surgery
How will your research improve patient care: The FlowSafe device will improve patient care by providing an
effective and safe method of cerebrospinal drainage in a more cost
-saving manner than achieved with automated systems.
Author Disclosure Presenting Corresponding CoAuthor
Christina Duffin X
Jan Eckermann BeckerSmith Medical,
Inc.,,Ownership
Interest,N/A
X X
Susan Schaufelberger X
Robert Lieberson X
William Meyer X
Tung Trang X
