Related Experiment Videos
Preliminary experience with controlled external lumbar drainage in diffuse pediatric head injury
1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Ariz.
Pediatric Neurosurgery
|January 1, 1991
Summary
External lumbar subarachnoid drainage offers a potential solution for severe pediatric head injuries. This method effectively reduced intracranial pressure in children when other treatments failed, improving survival rates.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Management
Background:
- Severe pediatric head injuries often lead to refractory intracranial hypertension.
- Initial management includes ventriculostomies and maximal medical therapy.
- Some cases require surgical evacuation of mass lesions.
Observation:
- Five pediatric patients with severe diffuse head injuries and Glasgow Coma Scale scores ≤8 were treated.
- All patients developed high intracranial pressure (ICP) unresponsive to conventional therapies.
- External lumbar subarachnoid drainage was implemented in refractory cases.
Findings:
- Lumbar drainage led to a significant ICP decrease in 3 of 5 patients.
- This reduction obviated the need for barbiturate coma and hyperventilation in these patients.
- ICP levels correlated with drainage bag height in survivors.
Implications:
- External lumbar subarachnoid drainage is a viable treatment for refractory intracranial hypertension in pediatric head injury.
- It may address posttraumatic cerebrospinal fluid circulation issues, cerebral edema, and venous hypertension.
- This approach shows promise when maximal medical and ventricular drainage strategies are insufficient.