{"id":"308f6eb8-93e8-4256-9dea-49ac99a46b80","slug":"refractory-intracranial-hypertension-in-traumatic-brain-injury-proposal-for-a-novel-score-to-assess-the-safety-of-lumbar-cerebrospinal-fluid-drainage","title":"Refractory intracranial hypertension in traumatic brain injury: Proposal for a novel score to assess the safety of lumbar cerebrospinal fluid drainage","authors":["Marlies Bauer","Florian Sohm","Claudius Thomé","Martin Ortler"],"abstract":"Background: Cerebrospinal fluid (CSF) drainage via ventricular puncture is an established therapy of elevated intracranial pressure (ICP). In contrast, lumbar CSF removal is believed to be contraindicated with intracranial hypertension. Methods: We investigated the safety and efficacy of lumbar CSF drainage to decrease refractory elevated ICP in a small cohort of patients with traumatic brain injury (TBI). A score (0–8 points) was used to assess computed tomography (CT) images for signs of herniation and for patency of the basal cisterns. All patients received lumbar CSF drainage either as a continuous drainage or as a single lumbar puncture (LP). Type and method of CSF drainage, mean ICP 24 h prior and after CSF removal, and adverse events were documented. Outcome was assessed after 3 months (with dichotomized Glasgow outcome scale). Results: Eight patients were evaluated retrospectively. n = 5 suffered a moderate, n = 2 a severe TBI (one Glasgow coma score not documented). The CT score was ≥5 in all patients prior to LP and decreased after puncture without clinical consequences in two patients. The amount of CSF removal did not correlate with score changes (P = 0.45). CSF drainage led to a significant reduction of mean ICP (from 22.3 to 13.9 mmHg, P = 0.002). Continuous drainage was more effective than a single LP. Three of eight patients reached a favorable outcome. Conclusions: Lumbar CSF removal for the treatment of intracranial hypertension is effective and safe, provided the basal cisterns are discernible, equivalent to ≥5 points in the proposed new score. The score needs further validation.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/308f6eb8-93e8-4256-9dea-49ac99a46b80/featured/hero-1782420844711.png","publishDate":"2017-11-01T00:00:00.000Z","doi":"10.4103/sni.sni_98_17","categories":["Trauma","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/308f6eb8-93e8-4256-9dea-49ac99a46b80/pdf"}