title: Dura-arachnoid lesions produced by 22 gauge Quincke spinal needles during a lumbar puncture.
abstract: OBJECTIVE
  The dural and arachnoid hole caused by lumbar puncture needles is a determining factor in triggering headaches. The aim of this study is to assess the dimensions and morphological features of the dura mater and arachnoids when they are punctured by a 22 gauge Quincke needle having its bevel either in the parallel or in the transverse position.
  
  
  METHODS
  Fifty punctures were made with 22 gauge Quincke needles in the dural sac of four fresh cadavers using an "in vitro" model especially designed for this purpose. The punctures were performed by needles with bevels parallel or perpendicular to the spinal axis and studied under scanning electron microscopy.
  
  
  RESULTS
  Thirty five of the 50 punctures done by Quincke needles (19 in the external surface and 16 in the internal) were used for evaluation. When the needle was inserted with its bevel parallel to the axis of the dural sac (17 of 35), the size of the dura-arachnoid lesion was 0.032 mm(2) in the epidural surface and 0.037 mm(2) in the subarachnoid surface of the dural sac. When the needle's bevel was perpendicular to the axis (18 of 35) the measurement of the lesion size was 0.042 mm(2) for the external surface and 0.033 mm(2) for the internal. There were no statistical significant differences between these results.
  
  
  CONCLUSIONS
  It is believed that the reported lower frequency of postdural puncture headache when the needle is inserted parallel to the cord axis should be explained by some other factors besides the size of the dura-arachnoid injury.
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital de Móstoles, Madrid, Spain. miguelangel.rei@terra.es
authors.forename: M A
authors.initials: MA
authors.lastname: Reina
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: V
authors.initials: V
authors.lastname: Badorrey
authors.forename: J A
authors.initials: JA
authors.lastname: De Andrés
authors.forename: S
authors.initials: S
authors.lastname: Martín
mesh_terms: D001099:Arachnoid / Q000293:injuries* / Q000473:pathology; D004388:Dura Mater / Q000293:injuries* / Q000473:pathology; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D066298:In Vitro Techniques; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects* / Q000145:classification; D013129:Spinal Puncture / Q000009:adverse effects* / Q000379:methods; D014950:Wounds, Penetrating / Q000209:etiology / Q000473:pathology*