Role of Lumbar Puncture In Traumatic Brain Injury

Abstract

Background: Cerebrospinal fluid (CSF) drainage via ventricular puncture is an established therapy ofelevated intracranial pressure (ICP). In contrast, lumbar CSF removal is believed to be contraindicated withintracranial hypertension.Method: We investigated the safety and efficacy of lumbar CSF drainage to decrease refractory elevatedICP in a small cohort of patients with traumatic brain injury (TBI). A score (0–8 points) was used to assesscomputed tomography (CT) images for signs of herniation and for patency of the basal cisterns. All patientsreceived lumbar CSF drainage either as a continuous drainage or as a single lumbar puncture (LP). Type andmethod 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 (oneGlasgow coma score not documented). The CT score was ?5 in all patients prior to LP and decreased afterpuncture without clinical consequences in two patients. The amount of CSF removal did not correlate withscore 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 afavorable outcome.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 scoreneeds further validation.