Name of the Procedure:

Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance. Commonly referred to as a lumbar puncture (LP) with imaging guidance.

Summary

A spinal puncture, or lumbar puncture, is a procedure where a needle is inserted into the lower part of the spinal column to drain cerebrospinal fluid (CSF). This procedure is guided by imaging techniques such as fluoroscopy or CT scan to ensure accurate placement of the needle.

Purpose

This procedure is performed to relieve pressure caused by an excess of cerebrospinal fluid. It can also be used to treat conditions such as hydrocephalus or to drain infected or otherwise abnormal CSF.

Indications

• Elevated intracranial pressure
• Hydrocephalus (excess fluid in the brain cavities)
• Infection or bleeding in the central nervous system
• Certain spinal and brain tumors
• Diagnostic use in cases where CSF analysis is required

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications may be necessary, particularly for blood thinners.
• Pre-procedure blood tests or imaging studies may be required to assess the patient's condition.

Procedure Description

1. The patient is positioned on their side or stomach to expose the lower back.
2. The skin is sterilized, and local anesthesia is administered to numb the area.
3. Under fluoroscopic or CT guidance, a needle or catheter is carefully inserted between the vertebrae into the spinal canal.
4. Cerebrospinal fluid is drained as necessary.
5. The needle or catheter is removed, and a bandage is applied to the puncture site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or specialized outpatient clinic with radiological facilities.

Personnel

• Radiologist or interventional radiologist
• Nurse
• Technician specialized in radiological or CT equipment
• Possibly an anesthesiologist or nurse anesthetist, if sedation is used

Risks and Complications

• Headache
• Infection
• Bleeding or hematoma
• Nerve damage
• Persistent CSF leakage
• Rarely, back pain or discomfort at the puncture site

Benefits

• Relief from symptoms caused by excess cerebrospinal fluid
• Diagnosis and treatment efficacy for various neurological conditions
• Minimally invasive nature with the use of imaging guidance improving accuracy

Recovery

• Patients are usually observed for a few hours post-procedure.
• They should avoid strenuous activities for 24-48 hours.
• Drinking plenty of fluids can help reduce headache risk.
• Follow-up appointments may be needed to monitor recovery and response to treatment.

Alternatives

• Shunt surgery for chronic conditions like hydrocephalus
• Medications to reduce cerebrospinal fluid production or relieve symptoms
• Endoscopic third ventriculostomy (ETV) for certain types of hydrocephalus

Patient Experience

During the procedure, patients may feel pressure or slight discomfort when the needle is inserted. Post-procedure, they may experience headaches or back discomfort, managed with pain relievers and adequate hydration. Comfort measures include lying flat for a period after the procedure to minimize headache risks.