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Lumbar Drain

Last Updated: September 27, 2018

Placement of Lumbar Drain

Lumbar drainage of cerebrospinal fluid (CSF) has many applications in neurosurgery. It can be used for decompression of CSF spaces, management of intracranial hypertension, and repair of a CSF leak or fistula. Clinical indications, successful insertion, and postoperative management are important skills that will be reviewed here.

One-time lumbar puncture may be performed as a diagnostic measure or when large volume CSF drainage is unnecessary. For example, I perform a lumbar puncture immediately before a retromastoid craniotomy. This maneuver allows drainage of ~35 cc of CSF and provides a smooth and unobstructed reach toward the cerebellopontine angle cisterns and around the relaxed hemisphere, with minimal retraction on the cerebellum. In general, I have a l...