Skip Navigation LinksHome > March 2011 - Volume 68 - Issue > Cervical Subarachnoid Catheter Placement for Continuous Cere...
Neurosurgery:
doi: 10.1227/NEU.0b013e318207b20a
Operative Technique: Editor's Choice

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

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Abstract

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.

Copyright © by the Congress of Neurological Surgeons

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