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Intracranial Pressure Monitoring via a lumbar catheter

To measure the pressure of the cerebrospinal fluid (CSF) in your brain, your doctors will use a lumbar catheter, which is a small, flexible tube that is placed in the lumbar spine. This tube measures the pressure of the cerebrospinal fluid in the brain. This is a diagnostic test. It will not treat your symptoms. This test will help us determine if high or low pressures are the cause of your symptoms. The results from this test will help guide treatment which may include medicines or surgery.

Learn more: Read our Monitoring Intracranial Pressure via a Lumbar Catheter patient information handout.

The Procedure

  • A needle will be put in your arm to give you a medicine to reduce the risk of infection (antibiotic).
  • You will be asked to sit in a special chair or lie down on one side of the bed.
  • The area where the spinal needle is placed will be marked with a marking pen.
  • The lower back will be cleaned with a solution and allowed to dry.
  • The back will be covered by a sterile drape.
  • A medicine to numb your skin will be injected in the skin, which may cause burning for a few minutes.
  • The spinal needle will then be inserted in the area marked and directed towards the spinal canal. If there is arthritis of the spine, the needle may have to be re- directed until the right space is reached.
  • You will feel pressure as the needle is put in the back. If you feel a sharp pain, you should let the doctor know so that more anesthetic can be given.
  • A flexible tube is inserted through the needle.
  • The needle is withdrawn and the tube is held to the lower back with a bandage and connected to a pressure transducer.

What equipment is used for the procedure?

Medicine to reduce infection, spinal needle, tube, bandage, and pressure transducer.

How long/often are the treatments performed?

We measure your pressure for 24-72 hours. Normally, we measure spinal fluid pressure with a lumbar puncture. A lumbar puncture provides only a spot measurement whereas this procedure permits measuring pressure over a long time interval. Monitoring fluid pressure over 24 hours, however, can accurately detect intermittent increases in pressure. This procedure also allows measurement of pressure in different positions – lying, sitting, standing, etc. Knowing your correct fluid pressure will help us to better treat and understand your condition.

What do I need to do to prepare for the procedure?

You will be scheduled 3-7 days before your drain to run a few tests. Lab tests, including blood and urine tests, will be done to ensure you are safe to have the procedure, and have no bleeding tendency or infection. If these tests are abnormal, your procedure may be rescheduled.

What can I expect after the procedure is over?

Sometimes, after the lumbar drain is pulled out, fluid continues to leak from the small hole left by the tube. A simple stitch is placed in the skin to close the wound. The stitch is taken out in 1 week.

Analysis of the information obtained from this procedure and integrating it with other tests, (e.g., eye examination, shunt studies, MRI or CT scans) can take up to a week. Complex cases need to be discussed at the weekly case conference to provide the best course of treatment.

Are there side effects from the procedure?

Infection: There is a 3-4% risk of infection with this procedure, despite all safety measures. The infection, meningitis, is serious, but treatable with antibiotics, which need to be given intravenously for 14 days. This procedure has been performed over 1,000 times at Johns Hopkins and there has only been 1 death associated with lumbar drainage.

Leg or Back pain: Occasionally, while passing the spinal needle or catheter in the lumbar space, a nerve root may be touched. This causes a brief pain shooting down the back or leg. Moving the body to a different position usually alleviates the pain. There is rarely any lasting injury to the nerve root.

Headache: If too much fluid is removed, you may develop a headache. This headache will get worse when sitting or standing. You may also experience nausea or light-headedness. Stopping the fluid drain for a few minutes will usually alleviate the headache. Sometimes, you may develop a similar headache after the tube is removed. You should drink plenty of caffeine containing fluids and take ibuprofen or acetaminophen as needed. If this kind of headache persists, a blood patch may be applied to the area to plug the fluid leak.

Bleeding: Bleeding is minimal during the procedure. There is a potential for bleeding around the brain if excess fluid is drained. This procedure has been performed over 1,000 times and only one patient experienced blood inside the skull. This patient had to have surgery to remove the blood. To decrease the chance of this complication, please notify the nurse when you change positions or have to use the bathroom.

Dizziness or light-headedness: Sometimes you may feel light-headed or dizzy when you stand up. This may be a sign of excess fluid drainage and stopping the fluid drain for a few minutes could make the dizziness stop.

Spinal Fluid Leak: Rarely, spinal fluid may leak around the catheter and its dressing. If it leaks onto a non-sterile area, the physician may decide to remove the catheter. Depending on how much you have drained, a new one may be put in or multiple spinal taps may be done to drain more spinal fluid.

What symptoms do I need to report to my nurse or doctor during or after the procedure is over?

Let your physician know immediately –

  • If you develop a fever, severe headache, nausea or vomiting
  • If you get dizzy or light-headed when you sit or stand
  • If the lumbar drain tube or system gets disconnected
  • If you notice fluid in the bed or a leak from your lower back

What are the precautions following an extended CSF drainage procedure? 

Avoid straining or lifting heavy weights for 1 week. No swimming or bathing for 1 week. Showering is permitted. If there are any signs of delayed infection (fever with temperature over 101, stiff neck, nausea and vomiting, excessive sleepiness) your provider should be contacted immediately or report to the nearest emergency room for a lumbar puncture to evaluate for possible meningitis.

If there is a severe positional headache that resolves when lying down, there may be a persistent spinal fluid leak from the lumbar catheter insertion site. This should first be treated with increased fluid intake, and avoid straining or heavy lifting. If this headache is still present two days after discharge, arrangements will be made for an epidural blood patch.

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