Simultaneous lumbar and intraventricular manometry to evaluate the role and safety of lumbar puncture in raised intracranial pressure following subarachnoid haemorrhage

Kapadia, Farhad; Jha, Ajaya Nand

doi:10.1080/02688699646907

Cited by 13 publications

(11 citation statements)

References 4 publications

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“…17 A previously reported comparison of simultaneous lumbar and ventricular pressure in this setting demonstrated that both pressure readings reflect each other closely. 18 Drainage of 5 to 20 mL of CSF through a lumbar drain has been shown to approximately halve ICP in patients with aSAH and those with brain injury. 19 Additional benefits observed included an improvement in regional cerebral blood flow and brain tissue oxygen.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Al‐Tamimi

Bhargava

Feltbower

et al. 2012

Stroke

139

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Background and Purpose— A single-center prospective randomized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome. Methods— Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grades 2, 3, 4, and 3+4 were randomized to either the study group of standard therapy plus insertion of a lumbar drain or the control group of standard therapy alone. The primary outcome measure was the prevalence of delayed ischemic neurological deficit. Results— Two hundred ten patients with aneurysmal subarachnoid hemorrhage (166 female, 44 male; median age, 54 years; interquartile range, 45–62 years) were recruited into the control (n=105) and study (n=105) groups of the trial. World Federation of Neurological Surgeons grade was: 1 (n=139), 2 (n=60), and 3 (n=11); Fisher grade was: 2 (n=87), 3 (n=85), and 4 (n=38). The prevalence of delayed ischemic neurological deficit was 35.2% and 21.0% in the control and study groups, respectively ( P =0.021). The prevalence of a modified Rankin Scale score of 4, 5, or 6 at Day 10 and 6 months, respectively, was 62.5% and 18.6% in the control group and 44.8% and 19.8% in the study group ( P =0.009 and 0.83, respectively). Conclusions— Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage. Clinical Trial Registration— URL: www.clinicaltrials.gov . Unique identifier: NCT00842049.

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Section: Discussionmentioning

confidence: 99%

Lumbar Drainage of Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage

Al‐Tamimi

Bhargava

Feltbower

et al. 2012

Stroke

139

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“…Depending on the technique, ICP measuring can be undertaken in different intracranial anatomical locations: intraventricular, intraparenchymal, epidural, subdural, and subarachnoidal. Additionally, in patients with communicating CSF pathways, ICP may under certain circumstances be assessed by lumbar puncture [26, 27, 42, 43], as mentioned in the above chapter.…”

Section: Invasive Methods Of Measuring Icpmentioning

confidence: 99%

“…Additionally, in patients with subarachnoid hemorrhage or spontaneous ganglionic hemorrhage, the true intracranial pressure may be estimated by lumbar cerebrospinal fluid pressure [26, 27]. …”

Section: Introductionmentioning

confidence: 99%

Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods—A Review

Raboel

Bartek

Andresen

et al. 2012

Critical Care Research and Practice

294

326

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Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP.

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“…Clinical studies in a small number of patients demonstrated a significant reduction of increased ICP in response to controlled lumbar CSF drainage without any signs of cerebral herniation. 1,10,19,21,39 In researching this issue, we have demonstrated a significant reduction in ICP by using controlled lumbar CSF drainage according to defined indications in 23 patients with either TBI or SAH. 28 Signs of herniation were observed temporarily in 2 patients in that series.…”

mentioning

confidence: 99%