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LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 2  |  Page : 338
 

A “Guided” technique for insertion of lumbar cerebrospinal fluid drains


Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication6-Jan-2017

Correspondence Address:
S G Bakshi
Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.197736

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How to cite this article:
Bakshi S G, Praveen N B, Patil V. A “Guided” technique for insertion of lumbar cerebrospinal fluid drains. Indian J Cancer 2016;53:338

How to cite this URL:
Bakshi S G, Praveen N B, Patil V. A “Guided” technique for insertion of lumbar cerebrospinal fluid drains. Indian J Cancer [serial online] 2016 [cited 2019 Dec 9];53:338. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/338/197736


Sir,

The role of lumbar cerebrospinal fluid (CSF) drainage following resection of skull base tumors is known.[1] Placement of these catheters can be challenging.[1] We present a “guided technique” for insertion of lumbar CSF drains, which was used, after failure of the conventional technique.

A young adult presented with cerebrospinal fluid rhinorrhea following endoscopic resection of sinonasal neuroendocrine tumor. Decision to place a CSF drain (Ceflui, Surgiwear, India) was taken. Despite multiple attempts, two experienced anesthesiologists could not locate the spinal space with the 14-gauge metallic Tuohy needle. After consenting and adequate positioning, a reattempt was made the next day under all sterile conditions. The spinal space was first located in L3–L4 space using a 25-gauge Quincke needle (BD, USA) by midline approach. Free flow of CSF confirmed accurate placement. Before the skin puncture with the 14-gauge Tuohy needle, a small nick was made using a 22-gauge hypodermic needle, after adequate local anesthesia.[2] The placement of the metallic needle was then facilitated using the direction and depth of space as determined by the 25-gauge Quincke needle. After confirming free flow of CSF, the drainage catheter was passed without any resistance. The drainage functioned well and was removed after 6 days. This technique helped us with insertion of the lumbar CSF drain in a couple of other patients, in whom experienced anesthesiologists failed to locate the space using the 14-gauge metallic needle by conventional technique.

All lumbar CSF kits share common features and include a 14-gauge metallic Tuohy needle, a steel guidewire, and a siliconized catheter.[1] Locating the spinal space with 14-gauge blunt Tuohy is difficult as the feel of the ligaments is different when compared to the regular cutting spinal needles.[2],[3] The initial use of a 25-gauge Quincke spinal needle, as a guide needle, helps in localization of the CSF space. Relocating the space now with the metallic needle is simpler using the same puncture point and advancing the needle in the predetermined direction, safely, after removal of the 25-gauge spinal needle. Failure of clinical methods in the placement of lumbar drain is known, and use of fluoroscopy and ultrasound has been described.[4] Equipment availability and expertise in these techniques is essential.[4] The guided technique described is simple, effective, and beneficial in augmenting the standard technique of placement of lumbar drains.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Olivar H, Bramhall JS, Rozet I, Vavilala MS, Souter MJ, Lee LA, et al. Subarachnoid lumbar drains: A case series of fractured catheters and a near miss. Can J Anaesth 2007;54:829-34.  Back to cited text no. 1
    
2.
Arendt K, Demaerschalk BM, Wingerchuk DM, Camann W. Atraumatic lumbar puncture needles: After all these years, are we still missing the point? Neurologist 2009;15:17-20.  Back to cited text no. 2
    
3.
Calthorpe N. The history of spinal needles: Getting to the point. Anaesthesia 2004;59:1231-41.  Back to cited text no. 3
    
4.
Chin KJ, Perlas A. Ultrasonography of the lumbar spine for neuraxial and lumbar plexus blocks. Curr Opin Anaesthesiol 2011;24:567-72.  Back to cited text no. 4
    



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