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At least 379 records · Page 21Linked to original sources
PubMed1987

Combined CT metrizamide syringography and needle aspiration of cystic intramedullary spinal cord lesions.

A modified spinal cord puncture technique that was combined with CT metrizamide syringography for the evaluation of potentially cystic spinal cord lesions has been used in 5 patients. This procedure proved to be safe and efficacious in the preoperative differentiation of cystic neoplasms from syringohydromyelia. It also aided in planning a surgical approach by revealing details of the tumor location and/or syrinx dynamics. Spinal cord puncture associated with CT metrizamide syringography has a role in the diagnosis and therapy of patients with cystic spinal cord lesions.

Adult↗
PubMed1975

[Epidural spinal hematoma after lumbar puncture].

Three days after a lumbar puncture in a 7 month old child with pyogenic meningitis and without any blood clotting defect, appeared symptoms of spinal cord compression. Myelography led to surgery, 5 days after the puncture. At operation, an epidural hematoma, from L1 to L5 was removed. The exceptional character of this accident and its cause are discussed.

Hematoma, Epidural, Cranial↗
PubMedDate not supplied

Postdural puncture headache after continuous spinal anesthesia with 18-gauge and 20-gauge needles.

BACKGROUND AND OBJECTIVES: To evaluate the incidence of postdural puncture headache (PDPH) associated with continuous spinal anesthesia, 200 male patients (mean age 65 years) were randomly assigned to receive spinal anesthesia in one of three ways: group 1, 50 patients with an 18-gauge Tuohy-Schliff needle/20-gauge catheter combination; group 2, 50 patients with a newly developed 20-gauge Quincke point needle/24-gauge catheter combination; and group 3, 100 patients (control group, single injection spinal anesthesia) with a 22-gauge Quincke point needle. METHODS: Every patient was followed up for 7 days postoperatively. RESULTS: The incidence of PDPH was 6% with each continuous technique and 2% in the control group (difference not statistically significant). One group 1 patient who required an initial dose of 35 mg of tetracaine and 100 mg of lidocaine has a persistent, incomplete S4-5 sensory nerve deficit. CONCLUSIONS: The incidence of PDPH associated with continuous spinal anesthesia is acceptable in appropriate clinical circumstances, but large initial doses of local anesthetic should not be administered.

Aged↗
PubMed2002

The effect of changing pressures on dural puncture and leak with various spinal needles on an in vitro model.

Postdural puncture headache is one of the most serious complications of spinal anesthesia. In this study, spinal needles of various types and shapes were used to investigate the amount of fluid leakage in dural puncture under various levels of pressures. Dura samples received from 10 cadavers were fixed in an in vitro model. The dural punctures were inflicted with 22 G, 25 G, and 27 G Quincke; 25 G Withacre; 25 G, 27 G Pencan, and 26 G Atraucan spinal needles. The fluid, which leaked during the process, was collected under the pressures of 0, 25, 50, 100, and 150 cm H(2)O in one-hour period for each level. The holes in the dura were studied under light microscope. While 22 G and 25 G Quincke needles were used, the fluid leakage directly correlated the amount of liquid, the diameter of the needle, and the pressure used. The puncture of 25 G Withacre and 25 G Pencan presented a leakage which did not significantly vary with the liquid pressure and was of lesser amount. In 26 G Atraucan, 27 G Pencan, and 27 G Quincke inflicted punctures, little liquid was collected and it did not vary with differing pressures. Thus, no significant correlation was established between the needle diameter and the puncture. It was concluded that the sharp-ended needles could not endure changes in the pressure. However, those needles with a very thin diameter and a pencil tip were considered as safe tools for anesthetical practices.

Aged↗
PubMed2006

Bevel direction and postdural puncture headache: a meta-analysis.

BACKGROUND: The effect of lumbar puncture needle bevel direction on the incidence of postdural puncture headache (PDPH) is somewhat controversial. We performed a meta-analysis of available trials to determine if bevel direction during lumbar puncture would influence the incidence of PDPH. REVIEW SUMMARY: Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966 to November 29, 2004) and abstracts from several national meetings (American Society of Anesthesiology, International Anesthesia Research Society, American Society of Regional Anesthesia, Society of Obstetric Anesthesia and Perinatology) for terms related to needle and bevel direction. Inclusion criteria were assessment of the incidence of PDPH after lumbar puncture with a cutting needle (eg, Quincke, Tuohy), comparison of a "parallel" (bevel oriented in a longitudinal or cephalad to caudad direction) to "perpendicular" (bevel oriented in a transverse direction) orientation during needle insertion, randomized trials, and trials primarily in adult populations. Data on study characteristics and incidence of PDPH were abstracted from qualified studies and subsequently analyzed. The search resulted in 52 abstracts from which the original articles were obtained and data abstracted, with ultimately a total of 5 articles meeting all inclusion criteria. Insertion of a non-pencil-point/cutting needle with the bevel oriented in a parallel/longitudinal fashion resulted in a significantly lower incidence of PDPH compared with that oriented in a perpendicular/transverse fashion (unadjusted rates of 10.9% versus 25.8%; odds ratio = 0.29 [95% CI = 0.17-0.50]). CONCLUSIONS: Our meta-analysis indicates that with use of a cutting needle, insertion in a parallel/longitudinal fashion may significantly reduce the incidence of PDPH, although the reasons for this decrease are unclear.

Arachnoid↗