Preliminary Experience with Controlled External Lumbar Drainage in Diffuse Pediatric Head Injury

Abstract

Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. Within 72 h of admission, all children manifested high intracranial pressures (ICP) refractory to maximal therapy, including hyperventi-lation, furosemide, mannitol, and barbiturate coma. After the institution of lumbar drainage, 3 of the 5 children had an abrupt and lasting decrease in ICP, obviating the need for continued barbiturates and hyperventilation. Three children survived, 2 of whom made good recoveries; 1 child is functional with disability. ICP varied passively with the height of the drainage bag in these surviving patients. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.

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

“…In concordance with Baldwin et al [2] lumbar drainage was only instituted in the presence of discernible basilar cisterns. Why some patients with un- Table 1.…”

“…To date, the use of lumbar drainage in uncontrollable intracranial hypertension has only been described in pediatric head injury [2,7]. Levy et al [7] hypothesized mechanisms comparable to pseudotumor cerebri as an explanation for the effects of lumbar drainage.…”

“…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.…”

Lumbar drainage of cerebrospinal fluid in a child with tetralogy of Fallot and cerebral infarct

“…It has shown a substantial and lasting decrease in intracranial pressure, obviating the need for continued barbiturates and hyperventilation. 3,4 Cerebrospinal fluid leak is the main non-endocrine postoperative complication associated with trans-sphenoidal surgeries (TSS). During surgery if there is a CSF leak, a lumbar drain is usually placed to drain CSF in order to decrease CSF volume and pressure.…”

Pump-Regulated Cerebrospinal Fluid Drainage

“…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.…”