Controlled lumbar drainage in pediatric head injury

Abstract

A retrospective study of external lumbar subarachnoid drainage in 16 pediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required surgical evacuation of focal mass lesions. All patients manifested high intracranial pressures (ICPs) refractory to aggressive therapy, including hyperventilation, furosemide, mannitol, and in some cases, artificially induced barbiturate coma. After lumbar drainage was instituted, 14 patients had an abrupt and lasting decrease in ICP, obviating the need for continued medical management of ICP. In no patient did transtentorial or cerebellar herniation occur as a result of lumbar drainage. It was also noted retrospectively that the patients in this study had discernible basilar cisterns on computerized tomography scans. Fourteen patients survived; eight made good recoveries, three are functional with disability, and three have severe disabilities. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric patients with severe head injury when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with elevated ICP, which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or white matter cerebral edema, can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

“…Other authors associate lumbar drainage with intraventricular drainage in order to improve ICP lowering 24 . Several neurosurgical centers around the world have used ventriculostomy catheters in patients with posttraumatic brain swelling.…”

External Lumbar Drainage in Uncontrollable Intracranial Pressure in Adults with Severe Head Injury: A Report of 7 Cases

“…Second-tier therapies such as decompressive craniectomies [5] have been described, and neuroprotective agents acting upon excitatory neurotransmitters are currently under investigation. Recently, however, controlled lumbar drainage has been described as another potentially useful treatment for pediatric patients with severe head injury and raised ICP despite maximum management strategies [2,7]. In this preliminary paper we report our experience with this treatment modality in a small group of seven adult patients with head injury in which agressive ICP and CPP control failed or became ineffective.…”

Pump-Regulated Cerebrospinal Fluid Drainage

“…Lumbar subarachnoid drainage is a widely employed strategy for the management of CSF fistula as well as the therapeutic removal of CSF in the management of elevated intracranial pressure [9, 10]. The system described has also been used in 42 adult patients at our institutions without significant complications [unpubl.…”

“…Numerous authors describe the use of a lumbar drain for the management of such widespread disorders as spinal intradural surgery, CSF leaks from electrode sites and after cochlear repair [1, 2, 3, 4, 5, 6]. In addition, therapeutic drainage of CSF to control intracranial pressure has been described [7, 8, 9]. Current CSF drainage strategies employ either volume regulation or pressure regulation of drainage.…”