The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle
The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle
复制标题
使用 Tuohy 针和传统针进行术中腰椎引流后颅内低血压的频率和严重程度
DOI：
10.3109/02688697.2015.1122172
复制
发表时间：
2016
影响因子：
1.1
通讯作者：
O. Al
中科院分区：
文献类型：
--
作者：
M. M. Hulou;M. Abd;W. Gormley;A. Zamani;Ian F. Dunn;O. Al
摘要背景：术中腰椎脑脊液（CSF）引流是颅脑和血管外科公认的技术。本研究的目的是评估使用两种不同技术（14 G Tuohy穿刺针与18 G传统穿刺针）进行术中腰椎引流后颅内低血压的频率和严重程度。方法回顾性分析94例开颅手术患者的临床资料和影像学检查结果，其中47例患者行术中腰大池引流，47例未行术中腰大池引流。27例（57.4%）患者使用14 G Tuohy针，20例（42.6%）患者使用18 G传统针。结果9例（19.1%）行腰大池引流术的患者在MRI上出现低颅压征象，对照组无一例出现低颅压征象。6/9例患者使用了14 G针头，导致严重并发症：1例患者发生迟发性颅内硬膜外血肿，需要紧急清除和血液补片。另一名患者出现嗜睡，需要两个硬膜外血液补丁，第三名患者有长期头痛。其余3/9例无症状或出现轻度头痛的患者使用了18 G针头。结论使用较小的18 G传统穿刺针治疗低颅压结局更好，使用14 G Tuohy穿刺针严重并发症的发生率更高。
Abstract Background Intraoperative lumbar cerebrospinal fluid (CSF) drainage is a well-recognised technique in cranial and vascular surgery. The goal of the study was to assess the frequency and severity of intracranial hypotension post-intraoperative lumbar drainage performed using two different techniques, a 14G Tuohy needle versus an 18G traditional needle. Methods The medical records and imaging studies of 94 patients who had undergone open cranial operation were retrospectively studied: 47 patients had intraoperative lumbar drainage and 47 patients did not. A 14G Tuohy needle was employed in 27 (57.4%) patients and an 18G traditional needle was employed in 20 (42.6%) patients. Results There were signs of intracranial hypotension on MR images in nine (19.1%) patients who had intraoperative lumbar CSF drainage; none of the patients in the control group exhibited the MR signs of intracranial hypotension. A 14G needle was used in 6/9 patients and resulted in severe complications: one patient developed a delayed intracranial epidural hematoma that required emergency evacuation and a blood patch. Another patient developed somnolence that required two epidural blood patches and a third patient had protracted headaches. The 18G needle was used in the remaining 3/9 patients who were asymptomatic or presented with mild headaches. Conclusion The use of the smaller 18G traditional needle was associated with better outcomes with regards to intracranial hypotension, and the frequency of severe complications was higher with the use of the 14G Tuohy needle.