Related Experiment Videos
Controlled lumbar drainage in pediatric head injury
D I Levy1, H L Rekate, W B Cherny
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Journal of Neurosurgery
|September 1, 1995
Summary
External lumbar subarachnoid drainage effectively reduced high intracranial pressure in pediatric severe head injury patients unresponsive to standard treatments. This intervention improved outcomes, offering a valuable option when other therapies fail.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Management
Background:
- Severe head injuries in children often lead to dangerously high intracranial pressure (ICP).
- Standard treatments like ventriculostomy and aggressive medical management may not always control refractory ICP.
- Identifying suitable candidates is crucial for effective intervention.
Observation:
- A retrospective study analyzed 16 pediatric patients with severe head injuries and Glasgow Coma Scale scores ≤8.
- All patients initially received ventriculostomy, with five requiring surgical evacuation of mass lesions.
- Patients exhibited high ICP despite maximal medical therapy, including barbiturate coma.
Findings:
- External lumbar subarachnoid drainage was initiated in patients with refractory high ICP.
- Fourteen patients experienced an abrupt and sustained decrease in ICP after lumbar drainage.
- No instances of transtentorial or cerebellar herniation occurred due to lumbar drainage.
- Patients with discernible basilar cisterns on CT scans showed positive responses.
Implications:
- Controlled external lumbar subarachnoid drainage is a viable treatment for pediatric severe head injury with uncontrolled ICP.
- This method can be effective when aggressive medical therapy and ventricular drainage fail.
- Lumbar drainage may address ICP issues related to cerebrospinal fluid circulation disruption and cerebral edema by accessing cisternal spaces.