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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

Broken catheter with loop.47-year-old male complained of inefficient cerebrospinal fluid drainage on day 4 after fluoroscopic-guided lumbar drainage procedure due to accidental disconnection. Computed tomography scan taken 11 days after procedure revealed that long loop had formed in catheter in posterior epidural space at L2/4 level (arrows), which was removed by operation (A, reformmated coronal image; B, axial image).
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Figure 4: Broken catheter with loop.47-year-old male complained of inefficient cerebrospinal fluid drainage on day 4 after fluoroscopic-guided lumbar drainage procedure due to accidental disconnection. Computed tomography scan taken 11 days after procedure revealed that long loop had formed in catheter in posterior epidural space at L2/4 level (arrows), which was removed by operation (A, reformmated coronal image; B, axial image).

Mentions: The lumbar drainage catheter was retained in the epidural space of one patient without technical failure during the procedure. In this case, the catheter was accidentally sheared off during catheter management in the ward on day 4 after the procedure. A lumbar spine CT scan revealed the location of the catheter at the L2-4 level (Fig. 4). The catheter was removed in an operation, and the patient was discharged 14 days later with no neurological deficit.


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)

Broken catheter with loop.47-year-old male complained of inefficient cerebrospinal fluid drainage on day 4 after fluoroscopic-guided lumbar drainage procedure due to accidental disconnection. Computed tomography scan taken 11 days after procedure revealed that long loop had formed in catheter in posterior epidural space at L2/4 level (arrows), which was removed by operation (A, reformmated coronal image; B, axial image).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Broken catheter with loop.47-year-old male complained of inefficient cerebrospinal fluid drainage on day 4 after fluoroscopic-guided lumbar drainage procedure due to accidental disconnection. Computed tomography scan taken 11 days after procedure revealed that long loop had formed in catheter in posterior epidural space at L2/4 level (arrows), which was removed by operation (A, reformmated coronal image; B, axial image).
Mentions: The lumbar drainage catheter was retained in the epidural space of one patient without technical failure during the procedure. In this case, the catheter was accidentally sheared off during catheter management in the ward on day 4 after the procedure. A lumbar spine CT scan revealed the location of the catheter at the L2-4 level (Fig. 4). The catheter was removed in an operation, and the patient was discharged 14 days later with no neurological deficit.

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