Last Updated: September 27, 2018
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...