scholarly journals A Case Report of Thalamic Infarction after Lumbar Drain: A Unique Cause of Perioperative Stroke?

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Daniel N. Kianpour ◽  
Thomas M. Nguyen ◽  
Arthur M. Lam
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Perioperative Stroke ◽  
Aneurysm Clipping ◽  
Lumbar Drain ◽  
Csf Drainage ◽  
Thalamic Infarction ◽  
Neurological Surgery ◽  
Intraoperative Hypertension ◽  
Thalamic Infarcts

In the case presented, a patient has an unexplained episode of hypertension during aneurysm clipping. Following the procedure, the patient was discovered to have bilateral thalamic infarctions unrelated to the vascular location of the aneurysm. After a review of the case, it becomes apparent that intracranial hypotension caused by lumbar over drainage of cerebrospinal fluid (CSF) is the likely cause of both the episode of intraoperative hypertension and the thalamic infarcts. It is often presumed that having an open dura protects against intracranial hypotension and subsequent herniation. We present this case to suggest that opening the dura might not be protective in all cases and anesthesiologists must pay particular attention to the rate of CSF drainage. Lumbar CSF drainage is a technique frequently employed during neurological surgery and it is important for anesthesiologists to understand the signs, symptoms, and potential consequences of intracranial hypotension from rapid drainage.

Tunneled lumbar drain

2002 ◽  
Vol 96 (6) ◽  
pp. 1130-1131 ◽  
Author(s):  
Michael Hahn ◽  
Raj Murali ◽  
William T. Couldwell
Keyword(s):  
Cerebrospinal Fluid ◽  
Lateral Position ◽  
Tuohy Needle ◽  
External Drainage ◽  
Content Type ◽  
Rapid Procedure ◽  
Lumbar Drain ◽  
Csf Drainage ◽  
Usual Manner ◽  
Fine Print

✓ The authors report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic cerebrospinal fluid (CSF) drainage. A standard lumbar puncture (LP) is performed with a large-bore Tuohy needle (14- to 16-gauge), the drainage catheter is advanced into the subarachnoid space, and the needle is removed. The free Tuohy needle is then passed from a lateral position and brought out through the initial LP site. The free catheter is fed through the needle, and the needle is removed. The drain is attached to an external drainage bag in the usual manner. The authors have found this method particularly useful in some skull base and spinal surgical applications in which longer term continuous CSF drainage is desired.

scholarly journals Prevention of Intra-Operative Cerebrospinal Fluid Leaks by Lumbar Cerebrospinal Fluid Drainage during Endoscopic Endonasal Trans- Sphenoidal Surgery for Pituitary Macroadenomas

2020 ◽  
Vol 10 (1) ◽  
pp. 52-56
Author(s):  
Mohammad Shahnawaz Bari ◽  
Shaireen Akhtar ◽  
Md Shamsul Alam ◽  
Md Atikur Rahman ◽  
Asifur Rahman ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Pituitary Macroadenoma ◽  
Endoscopic Endonasal ◽  
Lumbar Drain ◽  
Csf Drainage ◽  
Csf Leaks ◽  
Pituitary Macroadenomas

Aim and Objective: Postoperative cerebrospinal fluid leak is a recognized complication of endoscopic endonasal trans- sphenoidal surgery for pituitary macroadenomas. In this study we assess the utility of prophylactic use of lumbar drain in preventing intra-operative cerebrospinal fluid leakage during endscopic endonasal transsphenoidal surgery for pituitary macroadenoma which will ultimately reduce the rate of persistent post-operative cerebrospinal fluid leakage. Materials and Methods: 34 patients who underwent endscopic endonasal transsphenoidal surgery for pituitary macroadenoma were dividedd into two groups by non-probability convenient sampling technique. In one group of which lumbar subarachnoid drain were given just before induction of anesthesia named LD Group and another group went through conventional method without giving lumbar drain named No LD Group. In all patients of LD Group 20-30 ml of CSF was drawn through lumbar drain before giving dural incision. Valsalva maneuver was used in each group to identify intraoperative CSF leaks at the end of definitive surgery before repairing the sellar floor.Zero degree rigid endoscope was used in all cases. Intraoperative CSF leak was categorized as ‘Yes’ or ‘No’ which was decided by surgeon.Lumbar drains were removed within 24 hours of operation in 16 patients of LD Group and in case 1,who developed intraoperative CSF leak, lumbar drain was removed later. Results: Thirty four patients were eligible for inclusion, of which 17 were assigned to the LD Group and 17 to the no LD Group. There were no statistically significant differences in patient demographics, tumor pathology, or radiology between the two groups. In LD Group intraoperative CSF leak occurred in 1(5.9%) patient and leak did not occur in 16(94.1%) patients, in No LD Group intraoperative CSF leak occurred in 14(82.4%) patients and leak did not occur in 3(17.6%) patients. Intraoperative CSF drainage significantly reduced the incidence of intraoperative CSF leaks from 82.4% in the No LD group to 5.9% in the LD group (P < 0.001). There were no catheter related complications. Conclusion: Intraoperative CSF drainage significantly reduces the incidence of intraoperative CSF leakage in patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas. Bang. J Neurosurgery 2020; 10(1): 52-56

scholarly journals Evaluating the Role of Pre-operative Cerebrospinal Fluid Diversion by Lumbar Drain in Transnasal Transsphenoidal Tumor Surgeries

2021 ◽  
Vol 7 (2) ◽  
pp. 75-84
Author(s):  
Ajay Choudhary ◽  
◽  
Rahul Varshney ◽  
Pushkar Ranade ◽  
Kaviraj Kaushik ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Electrolyte Imbalance ◽  
Csf Leak ◽  
Common Symptom ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Lumbar Drain ◽  
Csf Drainage

Background and Aim: The major concerns related to the Endoscopic Endonasal Transsphenoidal (EET) surgery for sellar and suprasellar tumors include the risks of post-operative Cerebrospinal Fluid (CSF) leak, leading to morbidity and at times mortality, due to severe meningitis. Time is required to develop possible preventive measures that can reduce the risk of post-operative CSF rhinorrhea. The present study aimed to evaluate the effects of pre-operative CSF diversion by lumbar drainage in EET tumor surgeries on preventing post-operative CSF leak and its effect on the length of hospital stay. Methods and Materials/Patients: We conducted a prospective study on 20 patients with a pituitary tumor that underwent EET surgery between October 2018 and December 2019. Preoperative Lumbar Drain (LD) was inserted after induction in all explored patients. The tumor was excised with continuous intraoperative CSF drainage. Post-operatively, the LD was kept for 3 days and clamped for the next 24 hours. If no evidence of CSF rhinorrhea was present, it was removed. Complications related to CSF drainage, CSF leak, and hospital stays were evaluated. Results: Our study population consisted of 13(65%) men and 7(35%) women, with Mean±SD age of 39.8±10.71 years. The most commonly presented complaint was visual disturbance (60%) and the least common symptom was urinary disturbance (5%). The intra-operative leak was detected in 9(45%) patients, while the post-operative leak was present in only 1(5%) patient. LD blockage significantly contributed to post-operative CSF leak (P=0.001). The Mean±SD hospital stay in the post-operative period was 8.85±3.22 days with 65% of patients having a hospital stay of <7 days. Other post-operative complications (e.g. diabetes insipidus, electrolyte imbalance, and hormonal disturbances) were mainly responsible for prolonged post-operative hospital stay (P=0.001). Conclusion: Pre-operative LD, apart from helping to reduce the incidence of post-operative CSF leak, is not associated with an overall increased post-operative hospital stay.

Cervical Subarachnoid Catheter Placement for Continuous Cerebrospinal Fluid Drainage: A Safe and Efficacious Alternative to the Classic Lumbar Cistern Drain

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons52-ons56 ◽  
Author(s):  
Hamad I Farhat ◽  
Mohamed Samy Elhammady ◽  
Allan D Levi ◽  
Mohammad Ali Aziz-Sultan
Keyword(s):  
Cerebrospinal Fluid ◽  
Effective Alternative ◽  
Cerebrospinal Fluid Drainage ◽  
Lumbar Surgery ◽  
Intrathecal Catheter ◽  
Safe Alternative ◽  
Lumbar Drain ◽  
Csf Drainage ◽  
Lumbar Catheter ◽  
Procedural Complications

Abstract BACKGROUND: Cerebrospinal fluid (CSF) drainage serves an important role in the management of patients with established or potential CSF fistulae. Classically, a lumbar CSF drain has been used for this purpose and has been shown to be safe and effective. In certain cases, such as extensive previous lumbar surgery, a lumbar drain cannot be used. In such instances, a cervical CSF drain can be inserted via a lateral C1-2 puncture and provides an excellent and safe alternative. OBJECTIVE: To describe the technique, safety, and effectiveness of placing a cervical drain for CSF drainage. Pitfalls and possible complications and their avoidance are also discussed. METHODS: Twenty-seven cervical drains were placed in 24 patients with a mean age of 56.1 years (range, 19-82 years). There were 13 women and 11 men. All cervical drains were placed via a lateral C1-2 puncture under direct fluoroscopic vision. A standard Hermetic closed-tip lumbar catheter was used in all cases. The drains were in place for an average of 5.96 days (range, 3-11 days). CSF surveillance was performed on the day of placement as well as every 48 hours that the drain was in place. RESULTS: Cervical drain placement was achieved in all cases, allowing for continuous CSF drainage. No permanent procedural complications occurred. There were no instances of meningitis. CONCLUSIONS: Placement of a cervical intrathecal catheter for CSF drainage is a safe and effective alternative when lumbar access is contraindicated or not achievable.

Overt Cerebrospinal Fluid Drainage Is Not a Sine Qua Non for Paradoxical Herniation After Decompressive Craniectomy

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. E214-E215 ◽  
Author(s):  
Ralph Rahme ◽  
Michel W. Bojanowski
Keyword(s):  
Cerebrospinal Fluid ◽  
Decompressive Craniectomy ◽  
Intracranial Hypotension ◽  
Skin Flap ◽  
Endovascular Embolization ◽  
Trendelenburg Position ◽  
Transtentorial Herniation ◽  
Csf Drainage ◽  
Life Saving ◽  
Brain Sagging

Abstract OBJECTIVE AND IMPORTANCE Paradoxical transtentorial herniation is a rare but well-documented complication of cerebrospinal fluid (CSF) drainage in patients with large decompressive craniectomies. However, brain sagging in the absence of CSF hypovolemia has not been previously reported. CLINICAL PRESENTATION A 30-year-old woman suffered massive intracerebral hemorrhage from a small residual left frontal arteriovenous malformation 1 year following endovascular embolization and stereotactic radiosurgery. The patient initially presented in coma with left mydriasis and decorticate posturing and underwent emergent decompressive craniectomy, evacuation of the hematoma, and insertion of an intracranial pressure (ICP) monitor. Postoperatively, despite a depressed skin flap and low ICP readings, she continued to deteriorate neurologically, and CT revealed increasing midline shift, transtentorial herniation, and brainstem compression. INTERVENTION OR TECHNIQUE Although there was no history of CSF drainage, the diagnosis of brain sag was suspected, because herniation seemed to occur in the setting of intracranial hypotension. The patient was placed in a 15° Trendelenburg position and improved dramatically within hours. A few days later, she was fully awake and had purposeful movements with her left side, although she had persistent aphasia and right hemiplegia. CONCLUSION Although rare, paradoxical herniation in the setting of a large craniectomy defect may occur in the absence of CSF drainage. This entity should be suspected whenever transtentorial herniation occurs in conjunction with direct or indirect signs of intracranial hypotension. Placing the patient in the Trendelenburg position should be attempted, because this simple maneuver may turn out to be life-saving.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Cerebrospinal Fluid Drainage to Reverse Paraplegia after Endovascular Thoracic Aortic Aneurysm Repair

2000 ◽  
Vol 7 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Kurt Tiesenhausen ◽  
Wilfried Amann ◽  
Günter Koch ◽  
Klaus A. Hausegger ◽  
Peter Oberwalder ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Aortic Aneurysm ◽  
Neurological Deficit ◽  
Thoracic Aortic Aneurysm ◽  
Intrathecal Catheter ◽  
Descending Thoracic Aortic Aneurysm ◽  
Csf Drainage ◽  
Cord Injury ◽  
The Right ◽  
Aneurysm Repair

Purpose: To report a case of endovascular descending thoracic aortic aneurysm (TAA) repair in which delayed-onset paraplegia was reversed using cerebrospinal fluid (CSF) drainage. Methods and Results: A 74-year-old patient with a 6.0-cm TAA underwent endovascular stent-graft repair that involved overlapping placement of 3 Talent devices to cover the 31-cm-long defect. Twelve hours later, a neurological deficit occurred manifesting as left leg paralysis with paresis on the right. After urgent intrathecal catheter placement and drainage of cerebrospinal fluid for 48 hours, the neurological deficit resolved. The patient's clinical condition was normal and endoluminal exclusion of the TAA remained secure at 8-month follow-up. Conclusions: This case demonstrates the potential therapeutic role for CSF drainage to reduce the complications of spinal cord injury after endovascular thoracic aneurysm repair.

Unusual Presentation of Childhood Reversible Angiopathy: Aphasia due to Acute Bilateral Paramedian Thalamic Infarct

2018 ◽  
Vol 16 (04) ◽  
pp. 248-252
Author(s):  
Makram Othman ◽  
Leila Massoud ◽  
Fatma Kamoun ◽  
Chahnez Triki ◽  
Khadija Moalla
Keyword(s):  
Spatial Neglect ◽  
Unusual Presentation ◽  
Thalamic Infarction ◽  
Thalamic Lesions ◽  
Thalamic Aphasia ◽  
Thalamic Infarct ◽  
Normal Speech ◽  
Thalamic Infarcts

AbstractAn 8-year-old right-handed girl manifested aphasia after bilateral thalamic infarcts. The features of thalamic aphasia are similar to that of previously reported patients with thalamic lesions. Paucity of speech, reduced voice volume, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were preserved. Thalamic aphasia is usually associated with left thalamic lesions. Our patient also had spatial neglect and anosognosia probably due to right thalamic infarction. She had recovered near-normal speech after rehabilitation.

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