Ultrasound guidance for difficult lumbar puncture in children: pearls and pitfalls.
Pediatric lumbar puncture can be challenging or unsuccessful for several reasons. At the same time, the excellent sonographic window into the pediatric spine provides a distinct opportunity for ultrasound-guided lumbar puncture. Minimal cerebrospinal fluid and thecal displacement by subdural or epidural hematomas are common after failed clinical attempts. Ultrasound is useful for determining a safe infraconal level for subarachnoid access. Real-time guidance increases not only the success rate but also the safety of diagnostic lumbar puncture and injections for chemotherapy and myelography. In this article, we discuss clinical and technical factors for ultrasound-guided pediatric lumbar puncture.
Pediatric Interventional Radiology, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. Prakash.muthusami@sickkids.ca.
Prakash
http://orcid.org/0000-0002-7062-9571
P
Muthusami
Diagnostic Imaging, Sidra Medical and Research Center, Doha, Qatar.|Weill-Cornell Medical College, New York, NY, USA.
Ashley James
AJ
Robinson
Pediatric Interventional Radiology, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
Manohar M
MM
Shroff
D002648:Child; D002675:Child, Preschool; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007278:Injections, Spinal; D008297:Male; D056888:Patient Positioning; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000209:etiology; D013129:Spinal Puncture / Q000009:adverse effects / Q000379:methods*; D018084:Ultrasonography, Interventional
Cerebrospinal fluid; Interventional radiology; Lumbar puncture; Meningitis; Neonate; Subdural hematoma; Ultrasound