Fractured Lumbar Drain Catheter Retrieval Using an Endoscopic Transforaminal Approach to the Lumbar Spine.

Abstract

Background and importance: Lumbar drain placement is a common neurosurgical procedure, with several surgical and medical indications extending even beyond the specialty. One complication of placement is a fractured catheter fragment. In some circumstances, catheter retrieval is necessary which is classically performed through an open approach. Here, we present the only reported case of a retained lumbar drain catheter which was retrieved using a transforaminal endoscopic approach to the lumbar spine.

Clinical presentation: This is a 39 year-old woman who underwent an elective craniotomy with planned perioperative lumbar drain placement for cerebrospinal fluid diversion using a 14-gauge Tuohy needle. Placement was noted to be technically challenging, and during the final attempt on removal of the system, it was noted that the distal end of the catheter had been sheared and retained in the thecal sac. Postoperatively a computed tomography scan of the lumbar spine was obtained showing the catheter fragment which entered the thecal sac dorsally at the L3-4 level but penetrated the ventral dura traveling in the epidural space caudally and terminating in the left lateral recess of L4-5. Given its presumed epidural location near the left L4-5 lateral recess and foramen, the decision was made to attempt a left transforaminal endoscopic approach for catheter retrieval before resorting to a standard open surgery.

Conclusion: As minimally invasive spine techniques for spine surgery continue to evolve, we have highlighted the versatility of the endoscope in spine surgery as it was implemented in our case, allowing for reduced perioperative morbidity associated with retained spinal catheter retrieval.