title: Normal saline injection via lumbar puncture for the treatment of acute tonsillar herniation: a report of 45 cases.
abstract: OBJECTIVE
  Current treatment of apnea attributable to acute tonsillar herniation often is inadequate. This study was undertaken to verify the clinical usefulness of normal saline injection via lumbar puncture for the treatment of apnea secondary to acute tonsillar herniation.
  
  
  METHODS
  Between 1969 and 2009, 45 patients who had not regained spontaneous respiratory function after external ventricular drainage or removal of a supratentorial lesion via open craniotomy received an injection of normal saline via lumbar puncture. Patient data were retrospectively analyzed.
  
  
  RESULTS
  Eleven of the 45 patients regained spontaneous breathing and recovered fully (24.4%). Sixteen patients regained spontaneous breathing but died later (35.6%), and 18 patients did not regain spontaneous respiration (40.0%). The overall rate of effectiveness of injected normal saline was therefore 60.0%.
  
  
  CONCLUSIONS
  For patients with tonsillar hernia who did not regain spontaneous respiration after external ventricular drainage or removal of a supratentorial lesion, an aggressive approach may be considered. Injection of normal saline via lumbar puncture could improve outcome in some of these patients.
authors.affiliation: Department of Neurosurgery, the Second Hospital of Shandong University, Jinan.
authors.forename: Qinghu
authors.initials: Q
authors.lastname: Meng
authors.affiliation: Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Jinan.
authors.forename: Lin
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan.
authors.forename: Xingang
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Linyi People's Hospital, Linyi, People's Republic of China.
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Heng
authors.affiliation: Department of Neurosurgery, the Second Hospital of Shandong University, Jinan.
authors.forename: Chengwei
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Linyi People's Hospital, Linyi, People's Republic of China. Electronic address: chuanlin001@163.com.
authors.forename: Chang
authors.initials: C
authors.lastname: Fei
authors.affiliation: Department of Neurosurgery, the Second Hospital of Shandong University, Jinan. Electronic address: zhangqinglin@sdu.edu.cn.
authors.forename: Qinglin
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001049:Apnea / Q000188:drug therapy / Q000628:therapy; D002531:Cerebellum / Q000473:pathology; D014695:Cerebral Ventriculography; D003128:Coma / Q000209:etiology; D003399:Craniotomy; D004322:Drainage; D004632:Emergency Medical Services; D004677:Encephalocele / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D019635:Neurosurgical Procedures; D020127:Recovery of Function; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D013129:Spinal Puncture / Q000379:methods*; D015173:Supratentorial Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D014474:Unconsciousness; D055815:Young Adult
chemical_list: D012965:Sodium Chloride