Name of the Procedure:

Cisternal or Lateral Cervical (C1-C2) Puncture; with Injection of Medication or Other Substance for Diagnosis or Treatment

Summary

A cisternal or lateral cervical puncture involves inserting a needle into the cerebrospinal fluid (CSF) space at the base of the skull or upper neck. This procedure is performed for diagnostic or therapeutic purposes, such as administering medications directly into the CSF.

Purpose

• Medical Condition or Problem Addressed: This procedure is often used to diagnose conditions affecting the central nervous system (CNS) or to deliver treatments directly to the CNS.
• Goals or Expected Outcomes: To obtain CSF samples for laboratory analysis, relieve symptoms of CNS disorders, or administer medications that need to bypass the blood-brain barrier.

Indications

• Severe headaches or neurological symptoms of unknown origin.
• Suspicion of CNS infections, such as meningitis or encephalitis.
• Need for administration of chemotherapy or antibiotics directly into the CSF.
• Diagnostic imaging indicating abnormalities requiring further investigation.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours prior to the procedure, depending on the type of anesthesia or sedation used.
• Diagnostic Tests or Assessments: Blood tests and imaging studies (such as MRI or CT scans) to assess the patient's overall health and anatomy.

Procedure Description

1. Positioning: Patient is positioned typically lying on their side or sitting and leaning forward.
2. Sterilization: The skin over the neck or base of the skull is cleaned and sterilized.
3. Anesthesia: Local anesthesia is administered to numb the puncture site. Sedation may also be provided.
4. Needle Insertion: A thin needle is carefully inserted into the C1-C2 space or cisterna magna under imaging guidance.
5. Fluid Sample or Injection: CSF is extracted for analysis, or medications are injected into the CSF.
6. Needle Removal: The needle is removed, and a sterile bandage is applied to the site.

Tools and Equipment:

• Sterile needles and syringes
• Imaging technology (fluoroscopy or ultrasound)
• Sterile gloves and drapes

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Neurologist or neurosurgeon
• Radiologist (if imaging guidance is used)
• Registered nurse for assistance and monitoring
• Anesthesiologist (if sedation or general anesthesia is used)

Risks and Complications

• Common Risks: Headache, dizziness, nausea.
• Rare Risks: Infection at the puncture site, bleeding, nerve damage, CSF leak leading to severe headache, adverse reaction to medication.

Benefits

• Expected Benefits: Accurate diagnosis of CNS conditions, targeted delivery of medications, potential relief from symptoms.
• Timeline: Benefits can be immediate in terms of relief from pressure or delivery of necessary medication; diagnostic results can take a few days.

Recovery

• Post-procedure Care: Patients are typically monitored for a few hours post-procedure. They are advised to lie flat and stay hydrated to help prevent headaches.
• Expected Recovery Time: Most patients resume normal activities within 24 to 48 hours, though some may need longer depending on their overall health.
• Restrictions/Fallow-ups: Avoid strenuous activity for a few days. Follow-up appointments may be scheduled to review diagnostic results or assess treatment efficacy.

Alternatives

• Lumbar puncture (spinal tap) for CSF sampling from the lower spine, although it may not be as effective for certain CNS conditions.
• Non-invasive imaging studies (MRI or CT scans).
• Oral or intravenous medications with less direct access to the CNS.

Patient Experience

• During the Procedure: Patients might feel brief discomfort or pressure when the needle is inserted. Sedation helps minimize this.
• After the Procedure: Temporary headache or neck stiffness is possible. Adequate hydration and lying flat can help mitigate these symptoms. Pain management will be provided as necessary.