Dorothy FarrarCSF puncture
In cerebrospinal fluid puncture, the doctor pierces the external cerebrospinal fluid space of the spine with a hollow needle. For diagnostic purposes, the extracted cerebrospinal fluid is analyzed. Therapeutic cerebrospinal fluid punctures can introduce drugs into the cerebrospinal fluid space.
What is a CSF puncture?
The central nervous system feeds on cerebrospinal fluid, also called cerebrospinal fluid. The fluid washes around the human brain and spinal cord. In addition to the nutritional functions, the cerebrospinal fluid fulfills buffer functions. In a lumbar puncture or cerebrospinal fluid puncture, the doctor takes cerebrospinal fluid from the external cerebrospinal fluid space of the spine with a hollow needle. In cerebrospinal fluid diagnostics, pathological processes of the central nervous system can be read off from cerebrospinal fluid, such as bacterial infestation, autoimmune diseases or tumors.
Only the visual diagnosis allows statements about the state of the central nervous system. For example, if the cerebrospinal fluid is cloudy, there is probably inflammation. For precise analysis of its components, the cerebrospinal fluid sample is sent to the laboratory. Lumbar punctures not only play a role in diagnostics, but can also be a therapeutic step. For example, the extraction of cerebrospinal fluid can bring about intracranial pressure relief.
Applications
Typical areas of application of cerebrospinal fluid puncture:
CSF puncture is primarily used in neurological diagnostics. In neurogenic paralysis, movement disorders, severe headaches, perceptual impairments or other nervous system symptoms, cerebrospinal fluid diagnostics is now a standard examination procedure. Diseases and pathological processes change the composition of the cerebrospinal fluid. Several diseases of the brain and spinal cord can therefore be read from the results of the cerebrospinal fluid analysis.
In the context of acute bacterial brain inflammation, germs are usually detectable in the cerebrospinal fluid. Inflammatory diseases such as multiple sclerosis are reflected in the cerebrospinal fluid in the form of oligoclonal bands, i.e. as an accumulation of certain proteins and inflammatory cells. In malignant diseases, the cerebrospinal fluid changes just as frequently. Even if cerebral hemorrhage near the cerebrospinal fluid spaces is suspected, cerebrospinal fluid puncture can be helpful to diagnostics and, for example, confirm a subarachnoid hemorrhage.
In addition to these diagnostic applications, cerebrospinal fluid puncture is therapeutically relevant. By administering medication into the cerebrospinal fluid space, the blood-brain barrier can be bypassed. This connection plays a role, for example, for anesthetics before surgery or chemotherapy drugs in malignant diseases of the central nervous system. In addition, the puncture is used for cerebrospinal fluid congestion.
What methods and procedures are there?
For cerebrospinal fluid puncture, it is particularly important whether the procedure is intended to fulfil a diagnostic or therapeutic function. During diagnostic cerebrospinal fluid puncture, cerebrospinal fluid is taken. The same applies to therapeutic cerebrospinal fluid punctures for intracranial pressure reduction. All other therapeutic applications, on the other hand, do not extract cerebrospinal fluid, but give certain drugs or other substances into the cerebrospinal fluid space.
Whether something should be removed or something added plays a role above all in the selection of the instruments used. The hollow needle is used for removing liquor. If something is added, other needles are used. The doctor locates the outer CSF space and punctures it with the appropriate instrument. The basic methodology remains largely the same for all cerebrospinal fluid punctures.
What does the patient have to consider beforehand and during aftercare?
Before the lumbar puncture, the patient is informed about the procedure and its dangers and signs a declaration of consent. The posture of the patient plays a decisive role in the cerebrospinal fluid puncture. Ideally, the patient should sit hunched over during the procedure. If necessary, he assumes an embryonic position lying on his side until his elbows touch his knees. His posture is supported by a pillow. The patient’s head should be at approximately the same level as the planned lower back puncture site. In the horizontal position, the patient must keep his shoulders vertical so as not to twist the spine. Due to the strong flexion of the spine, the doctor has enough space to insert the needle.
During the procedure, the patient must remain as still as possible. If there is a tendency to Bleed , there is a contraindication for the cerebrospinal fluid puncture. The patient should discuss any known bleeding tendencies with the physician. Heparins must be discontinued about twelve hours before the lumbar puncture. Heparinization should not be continued earlier than two hours after the puncture.
In the case of inflammation of the tissue in the planned puncture area, the puncture should not be carried out due to the risk of infection. If pain such as a headache or pressure pain occurs after the procedure , the patient should not react with conventional painkillers , but should discuss the symptoms with the neurologist in charge.
Execution – How does the investigation work?
During the cerebrospinal fluid puncture, the doctor first disinfects the skin in the area of the planned puncture site. He discusses the procedure with the patient in advance. If desired by the patient, prior to the puncture he will inject a local anesthetic into the relevant area. As a rule, the anesthetic sets in completely after two minutes. Once this is the case, the doctor inserts the puncture needle.
The needle is inserted between two lumbar vertebrae . In most cases, a vertebral space between the third and fifth lumbar vertebrae is chosen for insertion. The choice of the puncture site is of great relevance in order to avoid injuries. The spinal cord ends at the level of the third to fifth lumbar vertebrae. This means that the puncture needle cannot injure any important structures.
If the doctor has applied the needle properly, he pierces through to the spinal canal. As soon as the spinal canal is reached, cerebrospinal fluid flows out of the needle. The doctor often also uses a riser tube that measures the cerebrospinal fluid pressure. The needle is withdrawn once sufficient CSF has been collected for laboratory testing. If the cerebrospinal fluid space was not hit directly, another puncture may be necessary. However, since the lumbar puncture is now a standard procedure, a repeat intervention is only necessary in the rarest of cases. The puncture is usually successfully completed within minutes.
Self-service or health insurance – who bears the costs?
The cerebrospinal fluid puncture is covered by health insurance. The patient does not have to dig into his own pocket. In this context, the indication is the decisive moment. As soon as the doctor confirms that a puncture is necessary, the health insurance companies will cover the full costs. If, on the other hand, the doctor advises against a lumbar puncture, the health insurance company may refuse to cover the costs. At least one deductible is usually due in this case. In addition, lumbar punctures are usually performed on an inpatient basis. For inpatient hospital stays, the deductible is around ten euros per day if there is no additional insurance.
Risks, complications and side effects
Serious consequences such as infections, bleeding or paralysis are now extremely rare after the lumbar puncture. However, about one percent suffers from post-puncture headache, which lasts between days and weeks. There is also a risk of hypotensive cerebrospinal fluid syndrome with dizziness , stiff neck , nausea or Photophobia and Ringing in the ears . To minimize discomfort, the doctor can apply a blood patch after the puncture, which closes the liquor leak. Substances such as caffeine have proven to be effective against the side effects of a cerebrospinal fluid puncture.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.