| Controlled lumbar drainage in medically refractory increased intracranial pressure. A safe and effective treatment. | |
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MedLine Citation:
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PMID: 19388295 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There have been no controlled trials of its use reported in the literature, to the best of our knowledge. METHOD: An IRB approved prospective study was conducted. 8 patients with increased intracranial pressure secondary to traumatic brain injury or aneurysm rupture were initially managed with sedation, ventriculostomy placement, mild hyperventilation (pCO2 = 30-35), and hyperosmolar therapy (Na = 150-155). A lumbar drain was placed if ICP continued to be above 20 mmHg despite optimization of medical therapy. FINDINGS: After lumbar drain placement, ICP was reduced from a mean of 27 +/- 7.8 to 9 +/- 6.3, an average decrease of 18 mm H2O (p < 0.05). Requirements for hypertonic saline and/or mannitol boluses and sedation to control ICP were also decreased. There were no complications noted. CONCLUSIONS: We have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols. |
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Authors:
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Ali Murad; Samer Ghostine; Austin R T Colohan |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Acta neurochirurgica. Supplement Volume: 102 ISSN: 0065-1419 ISO Abbreviation: Acta Neurochir. Suppl. Publication Date: 2008 |
Date Detail:
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Created Date: 2009-04-24 Completed Date: 2009-06-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100962752 Medline TA: Acta Neurochir Suppl Country: Austria |
Other Details:
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Languages: eng Pagination: 89-91 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Rm. 2562-B, Loma Linda, CA 92354, USA. amurad@llu.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Craniocerebral Trauma / surgery* Drainage / methods* Female Humans Intracranial Hypertension / etiology* Lumbosacral Region Male Middle Aged Prospective Studies Time Factors Treatment Outcome Ventriculostomy / adverse effects* Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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