Cerebral spinal fluid pressure - Effects of body position and lumbar subarachnoid drainage in a canine model
Cerebral spinal fluid pressure - Effects of body position and lumbar subarachnoid drainage in a canine model
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DOI：
10.1097/00007632-200301150-00005
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发表时间：
2003-01-15
期刊：
影响因子：
3
通讯作者：
Anderson, PA
中科院分区：
文献类型：
--
作者：
Carlson, GD;Oliff, HS;Anderson, PA
研究设计。本研究采用了一种蛛网膜下腔脑脊液压力测量的体内模型。探讨颈腰椎蛛网膜下腔脑脊液压力与体位变化的关系，验证增加体位倾斜度和腰椎蛛网膜下腔引流降低颈脑脊液压力的假说。背景资料摘要。脑脊液漏是颈椎前路或后路手术公认的并发症。关于术后患者体位和腰椎蛛网膜下腔引流的益处存在矛盾的意见。7只小猎犬的蛛网膜下腔脑脊液压力通过两根血管导管连接到压力传感器通过椎板切除术插入蛛网膜下腔。体位倾斜为30度、60度和90度时测量压力。腰椎硬膜切开术模拟腰椎蛛网膜下腔引流的效果。尸体被重新定位成90度，并测量了压力，结果。随着倾角从0度增加到90度，平均颈脑脊液压力显著降低。平均腰椎蛛网膜下腔压力随倾斜度从0度增加到90度显著增加。腰椎硬膜切开术加复位至90度可显著降低颈脑脊液蛛网膜下腔压力，压力下降46%。腰椎硬膜切开并复位至90度后，腰脑脊液蛛网膜下腔压降至零。颈椎和腰椎蛛网膜下腔的脑脊液压力受体位变化的影响。患者体位和腰椎引流对于降低颈椎脑脊液压力可能很重要，并可能减少颈部初次硬脑膜修复后脑脊液泄漏的发生。
Study Design. This study used an in vivo model of subarachnoid cerebrospinal fluid pressure measurement.Objectives. To examine the relation between subarachnoid cerebrospinal fluid pressure in the cervical and lumbar spine and varying body positions, and to test the hypothesis that increasing body inclination and lumbar subarachnoid drainage decreases cervical cerebrospinal fluid pressures.Summary of Background Data. Cerebrospinal fluid leaks are a recognized complication of anterior or posterior cervical surgery. Conflicting opinion exists regarding the benefits of postoperative patient positioning and lumbar subarachnoid drainage.Methods. Subarachnoid cerebrospinal fluid pressure of 7 beagles was monitored via two angiocatheters attached to pressure transducers inserted into the subarachnoid space through laminectomies at C3 and L4. Pressure measurements were taken when body position was inclined to 30degrees, 60degrees, and 90degrees. A lumbar durotomy was performed to simulate the effects of lumbar subarachnoid drainage. The body was repositioned to 90degrees, and pressure was measured.Results. As inclination increased from 0degrees to 90degrees, the mean cervical cerebrospinal fluid pressure significantly decreased. The mean lumbar subarachnoid pressure significantly increased as inclination increased from 0degrees to 90degrees. Lumbar durotomy plus repositioning to 90degrees resulted in a significant reduction in cervical cerebrospinal fluid subarachnoid pressure, with pressures dropping by 46%. Lumbar cerebrospinal fluid subarachnoid pressure dropped to zero after lumbar durotomy plus repositioning to 90degrees.Conclusions. Cerebrospinal fluid pressures in the subarachnoid space of both the cervical and lumbar spines are affected by changes in body position. Both patient positioning and lumbar drainage may be important in reducing cervical cerebrospinal fluid pressure, and may reduce the occurrence of cerebrospinal fluid leaks after primary dural repair-in the neck.