62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)

Name of the Procedure:

Spinal Puncture, Therapeutic for Drainage of Cerebrospinal Fluid
Commonly known as: Lumbar Puncture, CSF Drainage

Summary

A spinal puncture is a medical procedure where a needle or catheter is inserted into the lower back to drain cerebrospinal fluid (CSF). This can relieve pressure within the brain and spinal cord caused by excess fluid buildup.

Purpose

Medical Conditions Addressed:

• Hydrocephalus
• Intracranial hypertension
• Pseudotumor cerebri

Goals/Expected Outcomes:

• Reduce intracranial pressure
• Alleviate symptoms like headaches and vision problems
• Prevent long-term damage to the brain and spinal cord

Indications

Symptoms/Conditions:

• Severe and persistent headaches
• Blurred or double vision
• Nausea and vomiting
• Balance problems

Patient Criteria:

• Diagnosed with conditions leading to increased CSF
• Not responsive to less invasive treatments

Preparation

Pre-procedure Instructions:

• Fast for a specified period if sedation is used

• Adjust certain medications under physician guidance (e.g., anticoagulants)

  Diagnostic Tests:

• MRI or CT scan to assess brain and spinal cord condition
• Blood tests to ensure no bleeding disorders

Procedure Description

1. Positioning: Patient lies on their side or sits up and leans forward.
2. Anesthesia: Local anesthetic is applied to the lower back to numb the area.
3. Needle Insertion: A sterile needle or catheter is gently inserted into the lumbar region of the spine.
4. CSF Drainage: Once in place, cerebrospinal fluid is drained either through manual aspiration or continuous drainage using a catheter and bag.

Tools/Equipment:

• Sterile needles or catheters
• Collection bags
• Local anesthetics

Anesthesia/Sedation:

• Local anesthesia; sedation may be used in some cases

Duration

Typically takes about 30 to 60 minutes.

Setting

Usually performed in a hospital setting, either in a specialized procedure room or the neurology department.

Personnel

• Neurologist or Anesthesiologist
• Nurse or Nurse Practitioner
• Possibly an anesthesiologist if sedation is required

Risks and Complications

Common Risks:

• Headache
• Back pain
• Bleeding or infection at puncture site

Rare Complications:

• Nerve damage
• Persistent CSF leak
• Reaction to anesthesia

Benefits

• Relief from symptoms like severe headache and vision problems
• Reduced intracranial pressure
• Prevention of long-term neurological damage

Realization Time Frame:

• Immediate to a few hours after the procedure

Recovery

Post-procedure Care:

• Lie flat for several hours to reduce the risk of headache
• Maintain hydration to expedite recovery

Recovery Time:

• Most patients recover within 24 hours
• Avoid strenuous activity for a few days

Follow-up:

• Scheduled check-ups to monitor intracranial pressure and symptoms

Alternatives

Other Treatment Options:

• Medication to reduce CSF production
• Surgical procedures like ventriculoperitoneal (VP) shunt placement

Pros and Cons of Alternatives:

• Medications: less invasive but may not be effective for all
• VP Shunt: more permanent solution but involves surgical risks

Patient Experience

During the procedure, patients may feel pressure or slight discomfort in the lower back. Post-procedure, mild headache or back pain is common, which can be managed with over-the-counter pain medications and adequate hydration. Comfort measures include lying flat and avoiding strenuous activities for a few days.