Effects on intracranial pressure of dural puncture in supine and head-elevated positions. A study on the cat

Lumbar dural puncture may reduce intracranial pressure (ICP) due to a hydrostatic pressure gradient created by distal opening of the spinal fluid column towards the atmosphere. The magnitude of the reduction in hydrostatic force on the brain should depend on the vertical distance between the brain and the dural opening, and thus will increase by head elevation. No studies have analyzed ICP after dural puncture in supine and upright positions.

This study on the cat records ICP, mean arterial pressure, and central venous pressure before and after dural puncture in supine and head-elevated positions. The dural puncture was performed at a level corresponding to the lumbar region.

Initially ICP was 10.9 +/- 1.9 mmHg (mean +/- SD), which decreased to 5.1 +/- 2.0 mmHg after 24.5 cm (18 mmHg) of head elevation (n = 7). Intracranial pressure decreased to 5.2 +/-3.5 mmHg following dural puncture in the supine position and to -11.3 +/- 4.2 mmHg after the head elevation (n = 7). Active drainage of CSF fluid in the supine position in a volume similar to that spontaneously drained after head elevation reduced ICP by 2.0 +/- 0.5 mmHg (n = 3).

The results show that a significant ICP reduction may occur following opening of the spinal canal. The reduction can be explained more by hydrostatic forces than by loss of CSF; also explaining why it is more significant when upright than supine. The decrease in ICP increases transvascular pressure, which may induce the disappearance of the normally present subdural venous collapse with an increase in venous blood volume.