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Cervical Subarachnoid Catheter Placement for Continuous Cerebrospinal Fluid Drainage: A Safe and Efficacious Alternative to the Classic Lumbar Cistern Drain

Farhat, Hamad I MD; Elhammady, Mohamed Samy MD; Levi, Allan D MD, PhD; Aziz-Sultan, Mohammad Ali MD

doi: 10.1227/NEU.0b013e318207b20a
Operative Technique: Editor's Choice

BACKGROUND: Cerebrospinal fluid (CSF) drainage serves an important role in the management of patients with established or potential CSF fistulae. Classically, a lumbar CSF drain has been used for this purpose and has been shown to be safe and effective. In certain cases, such as extensive previous lumbar surgery, a lumbar drain cannot be used. In such instances, a cervical CSF drain can be inserted via a lateral C1-2 puncture and provides an excellent and safe alternative.

OBJECTIVE: To describe the technique, safety, and effectiveness of placing a cervical drain for CSF drainage. Pitfalls and possible complications and their avoidance are also discussed.

METHODS: Twenty-seven cervical drains were placed in 24 patients with a mean age of 56.1 years (range, 19-82 years). There were 13 women and 11 men. All cervical drains were placed via a lateral C1-2 puncture under direct fluoroscopic vision. A standard Hermetic closed-tip lumbar catheter was used in all cases. The drains were in place for an average of 5.96 days (range, 3-11 days). CSF surveillance was performed on the day of placement as well as every 48 hours that the drain was in place.

RESULTS: Cervical drain placement was achieved in all cases, allowing for continuous CSF drainage. No permanent procedural complications occurred. There were no instances of meningitis.

CONCLUSIONS: Placement of a cervical intrathecal catheter for CSF drainage is a safe and effective alternative when lumbar access is contraindicated or not achievable.

Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida

Received, September 21, 2009.

Accepted, June 3, 2010.

Correspondence: Hamad Issam Farhat, MD, Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL 33136. E-mail:

Copyright © by the Congress of Neurological Surgeons