Fluoroscopy-Guided Lumbar Drainage of Cerebrospinal Fluid for Patients in Whom a Blind Beside Approach Is Difficult

다국어 초록 (Multilingual Abstract)

To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage.
This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study.
The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal.
Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.

참고문헌 (Reference)

1 Governale LS, "Techniques and complications of external lumbar drainage for normal pressure hydrocephalus" 63 (63): 379-384, 2008

2 Post KD, "Technique for spinal drainage" 4 : 255-, 1979

3 Sato K, "Intraoperative fluoroscopy with contrast medium for correct lumbar catheter placement in lumboperitoneal shunts" 43 : 155-158, 2013

4 Eskey CJ, "Fluoroscopy-guided lumbar puncture : decreased frequency of traumatic tap and implications for the assessment of CT-negative acute subarachnoid hemorrhage" 22 : 571-576, 2001

5 Findler G, "Continuous lumbar drainage of cerebrospinal fluid in neurosurgical patients" 8 : 455-457, 1977

6 Gold MM, "Computed tomography-guided lumbar drain placement" 9 : 372-373, 2008

7 Graf CJ, "Complications of spinal drainage in the management of cerebrospinal fluid fistula" 54 : 392-395, 1981

8 Roland PS, "Complications of lumbar spinal fluid drainage" 107 : 564-569, 1992

9 Ac¸ikbas¸ SC, "Complications of closed continuous lumbar drainage of cerebrospinal fluid" 144 : 475-480, 2002

10 Brook AD, "Comparison of CT and fluoroscopic guidance for lumbar puncture in an obese population with prior failed unguided attempt" 6 : 324-328, 2014

11 Kitchel SH, "Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine" 71 : 984-987, 1989

12 Shapiro SA, "Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula" 30 : 241-245, 1992

13 Farhat HI, "Cervical subarachnoid catheter placement for continuous cerebrospinal fluid drainage: a safe and efficacious alternative to the classic lumbar cistern drain" 68 (68): 52-56, 2011

14 Coplin WM, "Bacterial meningitis associated with lumbar drains : a retrospective cohort study" 67 : 468-473, 1999