Lumbosacral and thoracolumbosacral cerebrospinal fluid volume changes in neonates, infants, children, and adolescents: A retrospective magnetic resonance imaging study

Abstract

Summary Background The volume of cerebrospinal fluid can affect the pharmacokinetics and pharmacodynamics of local anesthetics for spinal anesthesia and other intrathecal medications. Aims The objective of this study was to estimate the lumbosacral cerebrospinal fluid volume and thoracolumbosacral cerebrospinal fluid volume using magnetic resonance images in pediatric patients from neonates and infants to adolescents. Methods Spinal magnetic resonance images of 500 pediatric patients (age <18 years) were reviewed. The lumbosacral cerebrospinal fluid volumes of 418 patients and thoracolumbosacral cerebrospinal fluid volumes of 248 patients were measured. The relationship between cerebrospinal fluid volumes and age, height, and weight were evaluated. The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes per weight were calculated to elucidate developmental changes. Results The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes showed linear correlations with height (r2 = 0.730 and r2 = 0.661, respectively), whereas they showed curvilinear correlations with age (r2 = 0.752 and r2 = 0.717, respectively) and weight (r2 = 0.734 and r2 = 0.734, respectively). The mean lumbosacral cerebrospinal fluid volume per weight (mL/kg) was 0.85 (standard deviation [SD]: 0.19, 95% confidence interval [CI]: 0.81‐0.90) in neonates and infants, 0.86 (SD: 0.22, 95% CI: 0.83‐0.89) in toddlers and preschoolers, 0.71 (SD: 0.26, 95% CI: 0.66‐0.76) in schoolers, and 0.54 (SD: 0.20, 95% CI: 0.49‐0.60) in adolescents. The mean thoracolumbosacral cerebrospinal fluid volume per weight (mL/kg) was 1.95 (SD: 0.37, 95% CI: 1.86‐2.04) in neonates and infants, 1.82 (SD: 0.41, 95% CI: 1.75‐1.88) in toddlers and preschoolers, 1.38 (SD: 0.40, 95% CI: 1.23‐1.52) in schoolers, and 0.99 (SD: 0.34, 95% CI: 0.45‐1.53) in adolescents. Conclusion The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes in pediatric patients were much smaller than previously presented values, showing linear correlations with height, and demonstrate curvilinear correlations with age and weight.

Implementation of a spinal anesthesia and sedation protocol that reliably prolongs infant spinal anesthesia: Case series of 102 infants who received spinal anesthesia for urologic surgery

“…12,22 More recently, magnetic resonance imaging studies have shown CSF volumes in children that correlate with changes in height, age, and weight, but that are smaller than previously estimated. 23 Nonetheless, these physiologic mechanisms support the requirement for a higher dose of bupivacaine (0.8-1 mg/kg) than older children and adults. There are multiple studies examining the variation in local anesthetic dose requirements as infants age and gain weight.…”

“…Infants and neonates have different intrathecal pharmacodynamics and pharmacokinetics compared to adults because of a higher cerebrospinal fluid (CSF) volume, higher heart rate, increased CSF flow and turnover, larger volume of distribution, and greater clearance 12,22 . More recently, magnetic resonance imaging studies have shown CSF volumes in children that correlate with changes in height, age, and weight, but that are smaller than previously estimated 23 . Nonetheless, these physiologic mechanisms support the requirement for a higher dose of bupivacaine (0.8‐1 mg/kg) than older children and adults.…”

Pediatric spinal anesthesia at a tertiary care hospital: Eleven years after

“…In our study, two cases of PDPH (1%) were diagnosed in children aged 4 and 5 years in whom a 22G cutting spinal needle had been used. Using 25 G needle with a noncutting tip is therefore recommended as using larger needles, and cutting tips may be associated with a PDPH incidence up to 15% 11–12,16,30–32 …”

Increased chitotriosidase 1 concentration following nusinersen treatment in spinal muscular atrophy

“…Nusinersen is administered intrathecally in periodic doses of 12 mg in 5 ml independently from patients' age or height. Because height was shown to be related to spinal CSF volume [45,46], smaller individuals may attain higher drug levels relative to their CSF volume. In the course of treatment, we observed monocytic cells with indefinable, unspecified inclusions within the nusinersen-treated cohort of Dresden.…”