title: Controlled lumbar drainage in medically refractory increased intracranial pressure. A safe and effective treatment.
abstract: BACKGROUND
  A prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There have been no controlled trials of its use reported in the literature, to the best of our knowledge.
  
  
  METHODS
  An IRB approved prospective study was conducted. 8 patients with increased intracranial pressure secondary to traumatic brain injury or aneurysm rupture were initially managed with sedation, ventriculostomy placement, mild hyperventilation (pCO2 = 30-35), and hyperosmolar therapy (Na = 150-155). A lumbar drain was placed if ICP continued to be above 20 mmHg despite optimization of medical therapy.
  
  
  RESULTS
  After lumbar drain placement, ICP was reduced from a mean of 27 +/- 7.8 to 9 +/- 6.3, an average decrease of 18 mm H2O (p < 0.05). Requirements for hypertonic saline and/or mannitol boluses and sedation to control ICP were also decreased. There were no complications noted.
  
  
  CONCLUSIONS
  We have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols.
authors.affiliation: Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Rm. 2562-B, Loma Linda, CA 92354, USA. amurad@llu.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Murad
authors.forename: Samer
authors.initials: S
authors.lastname: Ghostine
authors.forename: Austin R T
authors.initials: AR
authors.lastname: Colohan
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects*; D055815:Young Adult