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

Chee CG, Lee GY, Lee JW, Lee E, Kang HS - Korean J Radiol (2015)

Bottom Line: 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.Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.

ABSTRACT

Objective: To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Epidural location of needle, which was not intrathecal position.Fluoroscopic-guided lumbar drainage showing flowing or lentiform-shaped appearance of contrast (arrow), indicating that needle position in posterior epidural space was inappropriate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4499551&req=5

Figure 1: Epidural location of needle, which was not intrathecal position.Fluoroscopic-guided lumbar drainage showing flowing or lentiform-shaped appearance of contrast (arrow), indicating that needle position in posterior epidural space was inappropriate.

Mentions: All procedures were conducted by fellow or staff radiologists who specialize in musculoskeletal disorders and had 1-10 years of experience. The patient was positioned in the left or right lateral decubitus position on a radiolucent operating table, and the puncture site was fluoroscopically confirmed using a standard angiography system with a rotatable C-arm (RF-1000-125; Philips Inc., Andover, MA, USA). A midline approach to the L3/4 interspinous space was preferred in most cases to avoid repeated puncture, as the L4/5 and L5/S1 interspinous spaces pose a greater risk of degenerative changes in our experience. The skin was prepped with Povidone-iodine solution and draped in a sterile fashion. After marking the skin puncture site with mosquito forceps, and administering 1% lidocaine locally, a 2-3 cm deep puncture was attempted initially without fluoroscopic guidance using an 18-gauge × 80-mm Tuohy needle. If this attempt failed, the needle tip was advanced gently under fluoroscopic guidance with lateral and antero-posterior (AP) views. When the needle tip traversed the spinolaminar line, which is a landmark of the posterior wall of the dura, the needle was advanced cautiously. The dura was punctured with a snap or rotation to avoid tenting the dura. Once CSF was encountered, contrast media was infused to confirm access to the subarachnoid space after removing the stylet. Diffuse spreading of the contrast media was typically observed after a successful puncture. If the needle was in the epidural space, the typical radiological findings were an irregularly shaped contrast pattern, with multifocal filling defects on the AP view, with contrast flowing along the spinolaminar line in the lateral view (Fig. 1). If the needle was in the subdural space, a typical "railroad track appearance" may be seen on the AP view and a thin linear line of contrast is seen on the lateral view (Fig. 2). The Tuohy needle was rotated to orient the bevel in the cranial direction, and the catheter was advanced 10-15 cm, slowly without resistance. If any resistance was encountered while advancing the catheter, the procedure was stopped, and contrast agent was used to confirm the location of the catheter tip and whether there was kinking or looping in the catheter. Finally, the level of the catheter tip was confirmed with contrast agent, which was usually positioned at the T12/L1 level. After connecting the drainage circuit to the catheter, the drain site was dressed with dry gauze and secured with transparent dressing (Tegaderm; 3M Health Care, St. Paul, MN, USA).


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

Chee CG, Lee GY, Lee JW, Lee E, Kang HS - Korean J Radiol (2015)

Epidural location of needle, which was not intrathecal position.Fluoroscopic-guided lumbar drainage showing flowing or lentiform-shaped appearance of contrast (arrow), indicating that needle position in posterior epidural space was inappropriate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499551&req=5

Figure 1: Epidural location of needle, which was not intrathecal position.Fluoroscopic-guided lumbar drainage showing flowing or lentiform-shaped appearance of contrast (arrow), indicating that needle position in posterior epidural space was inappropriate.
Mentions: All procedures were conducted by fellow or staff radiologists who specialize in musculoskeletal disorders and had 1-10 years of experience. The patient was positioned in the left or right lateral decubitus position on a radiolucent operating table, and the puncture site was fluoroscopically confirmed using a standard angiography system with a rotatable C-arm (RF-1000-125; Philips Inc., Andover, MA, USA). A midline approach to the L3/4 interspinous space was preferred in most cases to avoid repeated puncture, as the L4/5 and L5/S1 interspinous spaces pose a greater risk of degenerative changes in our experience. The skin was prepped with Povidone-iodine solution and draped in a sterile fashion. After marking the skin puncture site with mosquito forceps, and administering 1% lidocaine locally, a 2-3 cm deep puncture was attempted initially without fluoroscopic guidance using an 18-gauge × 80-mm Tuohy needle. If this attempt failed, the needle tip was advanced gently under fluoroscopic guidance with lateral and antero-posterior (AP) views. When the needle tip traversed the spinolaminar line, which is a landmark of the posterior wall of the dura, the needle was advanced cautiously. The dura was punctured with a snap or rotation to avoid tenting the dura. Once CSF was encountered, contrast media was infused to confirm access to the subarachnoid space after removing the stylet. Diffuse spreading of the contrast media was typically observed after a successful puncture. If the needle was in the epidural space, the typical radiological findings were an irregularly shaped contrast pattern, with multifocal filling defects on the AP view, with contrast flowing along the spinolaminar line in the lateral view (Fig. 1). If the needle was in the subdural space, a typical "railroad track appearance" may be seen on the AP view and a thin linear line of contrast is seen on the lateral view (Fig. 2). The Tuohy needle was rotated to orient the bevel in the cranial direction, and the catheter was advanced 10-15 cm, slowly without resistance. If any resistance was encountered while advancing the catheter, the procedure was stopped, and contrast agent was used to confirm the location of the catheter tip and whether there was kinking or looping in the catheter. Finally, the level of the catheter tip was confirmed with contrast agent, which was usually positioned at the T12/L1 level. After connecting the drainage circuit to the catheter, the drain site was dressed with dry gauze and secured with transparent dressing (Tegaderm; 3M Health Care, St. Paul, MN, USA).

Bottom Line: 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.Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.

ABSTRACT

Objective: To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus