Die Zisternenpunktion

A road less travelled: the centenary of cisterna magna puncture

“…4 ). In contrast to Ayer’s technique—in which the direction and depth of the needle was based on external anatomical landmarks and tactile feedback upon puncturing the occipito-atlantoid ligament, respectively—Eskuchen used the occipital bone as an ‘orientation point’ ( Eskuchen, 1928 ). In Eskuchen’s technique, the puncture needle was directed obliquely towards the posterior edge of the foramen magnum.…”

“…Once the occipital bone was encountered, the needle was slightly retracted and subsequently pushed forward at a somewhat declined angle, thereby entering the relatively spacious upper region of the cisterna magna. According to Eskuchen, his technique was much safer to that of Ayer’s, as the unreliability of tactile feedback supposedly caused physicians to be ‘in the dark when there is any deviation from the norm’ ( Eskuchen, 1928 ). This view was shared by most German-speaking authors, who widely adopted Eskuchen’s technique, whereas Ayer’s technique remained the method of choice in the USA.…”