Abstract Details

Title Cervical Puncture: An Important Tool for the Interventional Neurologist

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 259

Objective

Background BACKGROUND: Lateral cervical punctures were first described in the early 1960s. Over the last five decades, the role of cervical punctures has evolved from an approach for cervical cordotomies to a conduit for cervical myelograms, cervical drain placements, and diagnostic or therapeutic taps, among others. A wide array of indications include cervical myelography for inpatients with lower spinal block due to trauma, spinal tumors, or degenerative disease; subarachnoid hemorrhage; cisternography for CSF leak; idiopathic intracranial hypertension; as well as other standard indications for lumbar puncture.

Design/Methods DESIGN/METHODS: A retrospective review of all neurointerventional procedures performed at one institution from July 2009 - September 2012 was conducted to identify cervical puncture cases.

Results RESULTS: Six C1-2 punctures were performed by the senior author during a one-year period. Prior lumbar puncture was unsuccessful in all patients. Lateral C1-2 punctures were performed for diagnostic (3 patients) and therapeutic (cervical myelography; 3 patients) purposes via the following approaches: prone (4 patients), lateral decubitus (1 patient), and supine (1 patient). Indications included trauma with cervical spine fracture (2 patients), leptomeningeal metastasis, thoracic spinal block due to diffuse vertebral metastases, new-onset seizures, and subarachnoid hemorrhage. All but one patient were punctured in the posterior one-third of the spinal canal; one patient was punctured in the anterior one-third of the spinal canal. Technical success was 100%, and there were no immediate or delayed complications.

Conclusions CONCLUSIONS: Cervical punctures are infrequently performed due to insufficient exposure in neurointerventional training, limited indications, and a general perception that high cervical punctures are unduly risky. However, when proper technique is followed, they are safe, provide tremendous added value, and are an important tool in the interventional neurologist's arsenal.

Authors/Disclosures
Abraham P. Thomas, MD (A&S Genesis Neurology) PRESENTER	No disclosure on file
Sandra Narayanan, MD, FAAN	Dr. Narayanan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Narayanan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MicroVention.
Susan A. Eaton, PharmD (AbbVie)	No disclosure on file

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