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Extended CSF drainage trial via lumbar drain

What is a lumbar drain?

A lumbar drain is a small flexible tube that is placed in the lumbar spine. The tube drains some of the cerebrospinal fluid that fills the ventricles of the brain and surrounds the brain and spinal cord. In people with Normal Pressure Hydrocephalus, draining cerebrospinal fluid for a few days is helpful in determining if you will benefit from a shunt.

Learn more: Read our Spinal Fluid Drainage from a Lumbar Catheter patient information handout.

What will happen during the procedure?

  • An antibiotic will be given to reduce the risk of infection.
  • 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 inserted will be marked with a marking pen.
  • The lower back will be cleaned thoroughly with an antiseptic solution and allowed to dry.
  • The back will be covered by a sterile drape.
  • A local anesthetic 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 dull pressure as the needle is advanced. If you feel a sharp pain, you should let the doctor know so that more local anesthetic can be given.
  • Once the needle is in the right space, a flexible catheter is inserted through the needle.
  • The needle is then withdrawn and the catheter is held to the lower back with a sterile bandage and connected to a pressure transducer.

What equipment is used for the procedure?

IV antibiotic, spinal needle, flexible catheter, sterile bandage, and pressure transducer

How long does the procedure last?

We will drain spinal fluid for 2-3 days. This will let us know if you need a shunt. Even if you did not respond to a single large volume tap, this extended drainage will help us know if you may respond to a shunt.

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. You will have appointments with a physical therapist and an occupational therapist to test your balance and your ability to perform daily tasks. A doctor will assess memory and other brain functions. A nurse will test your walking. 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.

Any improvement in symptoms that you may experience in the hospital will only last for a few days. You should expect your symptoms to return to their usual state after you leave the hospital.

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
 

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