Lumbar cistern drainage (LCD) is used to treat intracranial infection, vasospasm after hemorrhage, intractable intracranial hypertension after craniocerebral trauma, cerebrospinal fluid leakage, and other related diseases (Wolf, 2015; Chen et al., 2017; Zwagerman et al., 2018; Badhiwala et al., 2021). It is widely used in the field of neurosurgery because of its reliable effect and obvious shortening of the course of disease. The premise for achieving therapeutic effects of lumbar cistern drainage is to maximize the drainage volume of cerebrospinal fluid and avoid complications such as headache and even cerebral herniation caused by excessive drainage volume (Sugrue et al., 2009).

The study confirmed that the drainage volume of cerebrospinal fluid (250–300 ml/d) is safe and effective (Ma et al., 2021). Insufficient drainage volume may affect the treatment effect and prolong the hospital stay. The most important reason for insufficient drainage is lumbar cistern blockage. After blockage, the cerebrospinal fluid cannot be drained smoothly or cannot flow out, which increases the treatment time. Replacing the lumbar cistern tube will increase cost for patients, and even more seriously, it may lead to intracranial infection and aggravate the condition of patients. Therefore, the goal is to prevent lumbar cistern blockage or recanalization after blockage to ensure continuous lumbar cistern drainage, and to avoid many complications after lumbar cistern drainage.

Although lumbar cistern drainage is a common and minimally invasive neurosurgery procedure, there is no systematic study on the risk factors for lumbar cistern blockage, and there are few reports on the methods of recanalization after blockage. This paper retrospectively analyzed 637 patients who required lumbar cisterna drainage after craniocerebral surgery for various reasons in our department, determined the risk factors for lumbar cisterna blockage and introduced the treatment experience of recanalization after blockage to provide guidance and reference values for clinical prediction.

Continuous drainage of cerebrospinal fluid from lumbar cistern drainage is one of the most commonly used treatment techniques in neurosurgery (Figures 1A, B). Its main purpose is to drain bloody or contaminated cerebrospinal fluid outside the skull. It is also sometimes used to monitor and control intracranial pressure and promote wound healing of cerebrospinal fluid rhinorrhea/otorrhea. Drainage tube blockage is a common complication of continuous lumbar cistern drainage. Once the tube is blocked, the daily drainage volume of cerebrospinal fluid decreases significantly or is completely absent, which hinders the purpose of treatment. At the same time, the existence of the drainage tube increases the possibility of infection (Fried et al., 2016). We retrospectively analyzed the risk factors for lumbar cistern blockage. (1) Cerebrospinal fluid characteristics [infection (Figure 1C) or blood] are the main reason for lumbar cistern blockage. The protein content in the infected cerebrospinal fluid is increased, viscous infectious secretion can be seen in the cerebrospinal fluid with the naked eye, and the bloody cerebrospinal fluid is mixed with blood clots, a large amount of hemoglobin and inflammatory factors after red blood cell disintegration. These abnormal impurities are easily attached to the inner wall of the drainage tube. With the accumulation of impurities, the diameter of the drainage tube gradually narrows or is even blocked completely. (2) The leakage of cerebrospinal fluid at the lumbar cistern puncture point is an early sign of lumbar cistern blockage, which indirectly indicates that the lumbar cistern is blocked, leading to increased pressure in the spinal canal and forcing cerebrospinal fluid to flow out of the puncture point (Figure 1D). We compared BMI, and the thickness of subcutaneous fat at the puncture point prevented cerebrospinal fluid leakage to some extent, but there was no significant difference. The most fundamental reason is that the drainage tube is blocked, which leads to an increase in local cerebrospinal fluid accumulation in the spinal canal, and when the pressure reaches a certain point, the cerebrospinal fluid exudes from the puncture point. (3) Daily drainage volume: lumbar cistern drainage can achieve maximum drainage while ensuring safety. Studies have shown that continuous drainage of 200 ml every day is safe (Wang et al., 2013), and some studies have confirmed that the maximum drainage volume should not exceed 300 ml (Ma et al., 2021), and this needs to be comprehensively evaluated according to the characteristics of individual conditions and clinical manifestations. Ensuring continuous drainage can reduce the probability of drainage blockage by continuously flushing and pushing CSF, drainage wall-attached infectious substances, blood clots, or proteins out. (4) As the duration of drainage increased (≥7 days), the probability of drainage tube blockage increased significantly, and the probability of infection caused by catheterization also increased significantly.

The risk factors for drainage tube blockage are identified, and corresponding disposal measures should be taken according to the risk factors. In the case of infection or bloody cerebrospinal fluid, clogging is prevented by prophylactic repeated extrusion of the drainage tube or by injecting saline through a syringe and with intermittent suction. Ensuring continuous drainage of 200 ml of cerebrospinal fluid every day and a catheterization duration <7 days can effectively avoid the possibility of cerebrospinal fluid leakage and infection at the puncture point. If the tube is blocked for unknown reasons, and to ensure safety, one should reduce the height of the drainage tube (low intracranial pressure), adjust the body position (the punctured intervertebral space is forced to compress the drainage tube), pull out part of the drainage tube in the spinal canal (the side hole of the drainage tube is adsorbed to the arachnoid), and the drainage tube may recanalize.

Lumbar cisterna drainage is a routine operation in neurosurgery. At the same time, it is also a double-edged sword that can be used to shorten the recovery time of patients. If used improperly, it will cause many adverse consequences. Therefore, after catheterization of the lumbar cisterna, the daily drainage volume (200–300/ml/day) and retention time (<7 days) should be maintained in strict accordance with the guidelines or existing research conclusions. This should be performed with a relatively sterile operation and careful disposal to prevent lumbar cisterna blockage and ensure continuous drainage and achieve the purpose of disease treatment.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Tangdu Hospital Ethics Committee. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

MZ: conceptualization and writing—original draft. QT: methodology. XW, LL, and XD: writing—original draft. YQ: supervision. QC: writing—review and editing. All authors contributed to the article and approved the submitted version.