CSF Lumbar Drainage: A Safe Surgical Option in Refractory Intracranial Hypertension Associated with Acute Posttraumatic External Hydrocephalus

2016 ◽  
pp. 55-59 ◽  
Author(s):  
R. Manet ◽  
E. A. Schmidt ◽  
F. Vassal ◽  
D. Charier ◽  
L. Gergelé
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Drainage ◽  
External Hydrocephalus ◽  
Surgical Option

scholarly journals External hydrocephalus in adults: an insidious cause of delayed intracranial hypertension. Report of 33 relevant cases treated with success by CSF lumbar drainage

2015 ◽  
Vol 12 (Suppl 1) ◽  
pp. P31
Author(s):  
Romain Manet ◽  
Romain Guerin ◽  
Orianne Martinez ◽  
Gilles Francony ◽  
Jean-Paul Roustan ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Drainage ◽  
External Hydrocephalus

A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury

2021 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Laura L Fernández ◽  
Juan P Ávila ◽  
Sarita Aristizabal ◽  
Andres M Rubiano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Lumbar Drainage ◽  
External Lumbar Drainage

External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review

2021 ◽  
Author(s):  
Andrew Robert Stevens ◽  
Wai Cheong Soon ◽  
Yasir Arafat Chowdhury ◽  
Emma Toman ◽  
Antonio Belli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Hypertension ◽  
Medical Therapy ◽  
Data Extraction ◽  
Lumbar Drainage ◽  
Safety Reporting ◽  
Sustained Effect ◽  
Cerebral Herniation ◽  
Adverse Patient Outcome ◽  
External Lumbar Drainage

Abstract BackgroundExternal lumbar drainage remains a controversial therapy for medically refractory intracranial hypertension in patients with acute TBI. This systematic review sought to compile the available evidence for the efficacy and safety of the use of lumbar drains for ICP control. MethodsA systematic review of the literature was performed with the search and data extraction performed by two reviewers independently in duplicate.ResultsNine independent studies were identified enrolling 230 patients, 159 with TBI. Efficacy for ICP control was observed across all studies, with immediate and sustained effect, reducing medical therapy requirements. Lumbar drainage with medical therapy appears effective when used alone and as an adjunct to ventricular drainage. Safety reporting varied in quality. Cerebral herniation (with unclear relationship to lumbar drainage) was observed in 14/230 patients resulting in one incident of morbidity without adverse patient outcome. ConclusionsThe available data is generally poor in quality and volume, but supportive of efficacy of lumbar drainage for ICP control. Few reports of adverse outcome are suggestive of, but are insufficient to confirm, safety of use in the appropriate patient and clinical setting. Further large prospective observational studies are required to generate sufficient support of an acceptable safety profile.

External lumbar drainage in progressive pediatric idiopathic intracranial hypertension

2021 ◽  
pp. 1-7
Author(s):  
Gad Dotan ◽  
Natalie Hadar Cohen ◽  
Hanya M. Qureshi ◽  
Mika Shapira Rootman ◽  
Yoram Nevo ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Symptom Relief ◽  
Visual Outcome ◽  
Fiber Layer ◽  
Lumbar Drainage ◽  
Lumbar Drain ◽  
Rnfl Thickness ◽  
External Lumbar Drainage

OBJECTIVE Pediatric idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure despite normal cerebrospinal fluid and neuroimaging findings. Initial management is typically medical; however, nearly 10% of children will eventually require surgery for persistent headache and/or vision loss. External lumbar drainage, which is a considerably safer treatment option, has not been adequately analyzed in children with medically refractory IIH. METHODS The authors conducted a single-institution retrospective analysis of children with medically refractory IIH who had undergone external lumbar drain (ELD) placement because of worsening papilledema, reflected as increased retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) testing. The main outcome measures were effects of external lumbar drainage on papilledema resolution, symptoms, and vision. RESULTS The authors analyzed the medical records of 13 children with IIH (11 girls, mean age 15.0 ± 2.3 years) whose mean CSF opening pressure was 45.5 ± 6.8 cm H2O. In all children, the average global RNFL thickness in both eyes significantly increased at ELD placement (right eye 371.8 ± 150.2 μm, left eye 400.3 ± 96.9 μm) compared with presentation thickness (right eye 301.6 ± 110.40 μm, left eye 350.2 ± 107.7 μm) despite acetazolamide medical therapy (20–30 mg/kg/day), leading to ELD placement after 9.5 ± 6.9 days (range 3–29 days). After ELD insertion, there was headache resolution, gradual and continuous improvement in optic disc thickness, and preservation of good vision. CONCLUSIONS ELD placement in children with medically refractory IIH who demonstrated worsening papilledema with increased RNFL thickening on OCT testing typically results in symptom relief and disc edema resolution with good visual outcome, often preventing the need for additional definitive surgeries that carry greater failure and morbidity risks.

Refractory posttraumatic intracranial hypertension: treatment with an external lumbar drainage

2005 ◽  
Vol 22 (Supplement 36) ◽  
pp. 9
Author(s):  
J. Homar ◽  
J. M. Abadal ◽  
J. A. Llompart ◽  
J. Perez ◽  
J. Ibáñez
Keyword(s):  
Intracranial Hypertension ◽  
Hypertension Treatment ◽  
Lumbar Drainage ◽  
External Lumbar Drainage

Lumbar drainage as treatment of refractory intracranial hypertension in bacterial meningitis

2008 ◽  
Vol 34 (6) ◽  
pp. 1166-1167 ◽  
Author(s):  
Etienne Javouhey ◽  
Nathalie Richard ◽  
Didier Stamm ◽  
Daniel Floret
Keyword(s):  
Bacterial Meningitis ◽  
Intracranial Hypertension ◽  
Lumbar Drainage

Neurologic Outcome of Posttraumatic Refractory Intracranial Hypertension Treated With External Lumbar Drainage

2007 ◽  
Vol 62 (2) ◽  
pp. 282-286 ◽  
Author(s):  
Josep M. Abadal-Centellas ◽  
Juan A. Llompart-Pou ◽  
Javier Homar-Ram??rez ◽  
Jon P??rez-B??rcena ◽  
Ainhoa Rossell??-Ferrer ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Neurologic Outcome ◽  
Lumbar Drainage ◽  
External Lumbar Drainage

Lumbar drainage for the treatment of refractory intracranial hypertension in HIV-negative cryptococcal meningitis

2019 ◽  
Vol 14 (10) ◽  
pp. 859-866
Author(s):  
Qilong Zhang ◽  
Hang Li ◽  
Keming Zhang ◽  
Amir Arastehfar ◽  
Farnaz Daneshnia ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Cryptococcal Meningitis ◽  
Control Group ◽  
Vision Disorders ◽  
Safe Alternative ◽  
Meningeal Irritation ◽  
Lumbar Drainage ◽  
Control Study ◽  
Hiv Negative

Aim: This study aims to evaluate lumbar drainage (LD) for controlling refractory intracranial hypertension among non-HIV cryptococcal meningitis patients. Patients & methods: A case–control study was designed to compare LD (case) with repeated lumbar puncture (control). Results: Both LD and repeated lumbar puncture can efficiently control refractory intracranial hypertension. LD group showed better clinical symptom remission, such as lower rate of headache, vision disorders, signs of meningeal irritation and conscious disturbance, than control group. LD group was reported with higher intracranial pressure reduction (173.75 ± 17.72 mmH2O) than those among control group (113.50 ± 14.94 mmH2O; p < 0.05). Conclusion: LD is an effective and safe alternative to control refractory intracranial hypertension in HIV-negative cryptococcal meningitis patients.

scholarly journals Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension

2021 ◽  
Author(s):  
Bernhard Schmidt ◽  
Marek Czosnyka ◽  
Danilo Cardim ◽  
Zofia Czosnyka ◽  
Bernhard Rosengarten
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Cerebral Blood Flow Velocity ◽  
Critical Threshold ◽  
Obese Women ◽  
Childbearing Age ◽  
Lumbar Drainage ◽  
Arterial Blood ◽  
The Mean

Abstract Purpose Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH. Materials and Methods nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH2O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed. Results In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH2O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH2O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH2O with both a sensitivity and specificity of 0.92. Presuming 20 cmH2O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases. Conclusion The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected.

Sign in / Sign up

Export Citation Format

Share Document