Role of Lumbar Puncture In Traumatic Brain Injury
Keywords:Intracranial hypertension, intracranial pressure, lumbar drainage, multimodality monitoring, score, traumatic brain injury.
Background: Cerebrospinal fluid (CSF) drainage via ventricular puncture is an established therapy of
elevated intracranial pressure (ICP). In contrast, lumbar CSF removal is believed to be contraindicated with
Method: We investigated the safety and efficacy of lumbar CSF drainage to decrease refractory elevated
ICP in a small cohort of patients with traumatic brain injury (TBI). A score (0–8 points) was used to assess
computed tomography (CT) images for signs of herniation and for patency of the basal cisterns. All patients
received lumbar CSF drainage either as a continuous drainage or as a single lumbar puncture (LP). Type and
method of CSF drainage, mean ICP 24 h prior and after CSF removal, and adverse events were documented.
Outcome was assessed after 3 months (with dichotomized Glasgow outcome scale).
Results: Eight patients were evaluated retrospectively. n = 5 suffered a moderate, n = 2 a severe TBI (one
Glasgow coma score not documented). The CT score was ?5 in all patients prior to LP and decreased after
puncture without clinical consequences in two patients. The amount of CSF removal did not correlate with
score changes (P = 0.45). CSF drainage led to a significant reduction of mean ICP (from 22.3 to 13.9 mmHg,
P = 0.002). Continuous drainage was more effective than a single LP. Three of eight patients reached a
Conclusions: Lumbar CSF removal for the treatment of intracranial hypertension is effective and safe,
provided the basal cisterns are discernible, equivalent to ?5 points in the proposed new score. The score
needs further validation.
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