Shoshina Vera Nikolaevna
Therapist, education: Northern medical University. Work experience 10 years.
Articles written
For many, brain puncture is subconsciously considered dangerous, but in fact it is not. If performed by an experienced doctor, it is absolutely safe. It is thanks to it that it is possible to detect ulcers in brain tissue, determine the contents of neoplasms and the state of other pathologies.
But there are also a number of dangers that can be encountered with this procedure. Let's figure it out.
The puncture is performed with a special needle, which, penetrating the brain tissue, can draw fluid from it. To make a puncture safe, you need to follow a number of rules:
- The area of the head where the puncture will be made must be thoroughly disinfected. First, it is treated with hydrogen peroxide, and then generously lubricated with iodine.
- For the procedure, you cannot use a regular needle, only a special puncture needle with a blunt end. It is produced quite wide and equipped with a mandrel.
- There should be 2 needles, one of which will be a spare if the first one is blocked by brain tissue.
- The puncture should be made to a depth of no more than 4 cm. This is the only way to ensure the safety of the fence and prevent the penetration of purulent secretions into.
- Before the procedure, the patient must have a bowel movement.
- The patient must be completely immobile, so he can be fixed with special devices.
Areas of application, indications, contraindications
Such a study is carried out in areas where there is suspicion of pus formation, most often these are:
- lower part of the frontal lobe;
- inferior part of the temporal lobe;
- tympanic space;
- near the mastoid process.
A puncture is taken to diagnose brain pathologies, such as:
- infectious lesion of the central nervous system;
- inflammatory process in the central nervous system;
- bacterial, viral, fungal diseases;
- infection of brain tissue with tuberculosis or syphilis;
- bleeding;
- multiple sclerosis;
- neoplasms of any type;
- neuralgic pathologies;
- swelling of brain tissue;
- problems with the vascular system.
Important! Before the procedure, the patient must indicate in a special questionnaire the list of medications that he is taking for this moment whether he is allergic to anesthetics or medications and whether he has problems with blood clotting.
The procedure is prohibited if:
- the patient is at any stage of pregnancy;
- he is in a state of traumatic shock;
- lost a lot of blood;
- there are intracranial hematomas;
- brain abscess diagnosed;
- abundant;
- diagnosed with hypertension;
- there are abundant infectious and purulent lesions on the back;
- there are lumbar bedsores;
- the brain is injured.
How to carry out the procedure
Why the procedure is being done has been determined, now you need to understand the methods for carrying it out. They are different and directly depend on the area where the liquid is taken.
Anterior horn of the lateral ventricle
The ventricular procedure for this area is performed as follows:
- The patient lies on his back when a tumor in the brain is to be identified. Usually the patient lies down on healthy side so that it is more convenient for the doctor to perform a puncture on the injured side.
- The head is slightly tilted towards the chest.
- The puncture site is thoroughly disinfected and coated with iodine twice.
- Draw a puncture line, which should be guided by the arrow-shaped seam, passing the Kocher point. It is covered with a layer of brilliant green solution.
- The head is covered with a sterile sheet.
- Any local anesthetic, to which the patient is not allergic, the puncture area is anesthetized, most often with Novocaine.
- Using a scalpel, an incision is made along the intended line.
- A cut is made on the trepanation window on the exposed skull.
- The neurosurgeon makes a cross-shaped incision on the dura mater. Wax is rubbed in or electrocoagulation is performed. For what? To stop bleeding, the latter method being the most effective.
- The cannula is inserted into the brain tissue to a depth of no more than 5-6 cm so that it runs parallel to the incision line. When puncturing the wall of the lateral ventricle, the doctor will feel a slight dip.
- Yellowish cerebrospinal fluid will begin to flow through the submerged cannula. Having penetrated the cavity of the ventricle, the doctor fixes the needle and, using a mandrel, regulates the volume and speed of the withdrawn fluid.
Often present in the ventricular cavity high pressure, and if it is not controlled, the liquid will come out in a stream. This will lead to the patient developing neuralgic problems.
The permissible volume of fluid intake is in the range of 3-5 ml. It is important to note that in parallel with the preparation of the room for the puncture, the operating room is also prepared, since there is high risk that air may enter the area being examined, or the puncture depth will be excessive, which may cause injury blood vessel. In these cases, the patient will be urgently operated on.
In cases of puncture, children use the methods of collecting cerebrospinal fluid according to Dogliotti and Geimanovich:
- In the first case, the puncture is carried out through the orbit.
- In the second - through the lower part of the temporal bone.
Both of these options have a significant difference from the traditional procedure - they can be repeated as often as needed. For infants, this procedure is carried out through an open fontanel, simply by cutting the skin above it. At the same time, there is serious danger that the baby will develop a fistula.
Posterior horn of the brain
The technology for collecting cerebrospinal fluid from the area is carried out in the following order:
- The patient lies on his stomach. His head is tightly fixed so that the sagittal suture is strictly in the middle cavity.
- The preparatory process is identical to the above procedure.
- The incision of the skull tissue is carried out parallel to the sagittal suture, but so that it passes through the Dandy point, which should be strictly in its middle.
- Take a needle number 18, which is used strictly for this type of puncture.
- It is inserted at an angle, directing the needle tip into the outer upper edge of the orbit to a depth of no more than 7 cm. If the procedure is performed on a child, the puncture depth should not exceed 3 cm.
inferior horn of the brain
The principle of the procedure is similar to the previous two:
- the patient should lie on his side, since the surgical field will be the side of the head and the auricle;
- the incision line will go 3.5 cm from the external auditory canal and 3 cm above it;
- part of the bone in this area will be removed;
- an incision will be made in the dura mater of the brain;
- insert a puncture needle 4 cm, directing it to the top of the auricle;
- cerebrospinal fluid will be collected.
Clinical picture after the procedure
Of course, the symptoms after puncture sampling are different for everyone, but they can be combined into a general clinical picture:
- Head pain different intensity and duration.
- Prolonged nausea and vomiting.
- Convulsions and fainting.
- Malfunction of the cardiovascular system.
- Violation respiratory function, in rare cases the patient may need artificial ventilation lungs.
- Neuralgic problems.
Whether the patient will have the above symptoms directly depends on the experience of the neurosurgeon and his skills. The procedure must be carried out strictly according to medical instructions, which can guarantee the absence of complications after puncture.
It is important not only to correctly fix the patient, but also to accurately determine the puncture area. Treatment of the affected area is important both at the stage of preparation for the procedure and after it. Upon completion of the collection, be sure to apply a sterile bandage.
It is important that the patient does not feel any discomfort, much less pain, at the time of the puncture.
Due to the fact that the procedure is most often prescribed for diagnosing pathologies, it is like any other diagnostic event, should be painless. The patient will be conscious at all times, so he should immediately inform the doctor about any discomfort that has arisen. This will help avoid a number of complications. The doctor will change the technology or completely interrupt the procedure.
Puncture is an important procedure in medicine, and taking cerebrospinal fluid from the brain even more so. Before the procedure, the patient will undergo a series of studies that will help identify possible contraindications. There is no need to worry; brain puncture is performed only by experienced specialists who know their job.
Otherwise, lumbar puncture is also called spinal cord. This is a very serious procedure. Cerebrospinal fluid for analysis. Since puncture is in many ways a risky event, it is prescribed only in cases of urgent need.
During the puncture procedure, the spinal cord, contrary to the name, should not be affected.
There are situations when, without lumbar puncture can't get by. This is due to the identification of infectious diseases in the patient, for example, meningitis, it can be prescribed to patients who have had a stroke, also to confirm multiple sclerosis and inflammation of the brain and spinal cord. In addition to this, puncture and as medical procedure for administering drugs in the presence of a hernia.
In any case, before prescribing a puncture, the doctor will conduct a number of other tests to make sure it is necessary, since the procedure may be. In order to take cerebrospinal fluid for analysis, lumbar region a puncture is made with a special needle. The puncture site should be below the spinal cord. After the needle is inserted, liquid begins to flow out of the canal.
In addition to analyzing the liquid itself, conclusions are also drawn based on the flow rate. If the patient is healthy, it will be transparent, only one drop will appear per second.
After the procedure is completed, the patient needs to lie on his back on a hard and flat surface for about two hours. It is also not recommended to sit or stand for about a day.
Is spinal tap dangerous?
What is the danger of a lumbar puncture? If the procedure is carried out correctly, no serious consequences the patient will not experience it. The main concerns are damage to the spinal cord and infection. In addition, the consequences include the appearance of bleeding, as well as in case of a brain tumor, increased intracranial pressure.
It should be noted that in qualified clinics only professional doctors perform spinal cord punctures. There should be no fear. A similar procedure can be compared with a conventional biopsy of one of the internal organs. However, without it it is impossible to make a correct diagnosis in time and cure the patient. Modern neurology is sufficiently developed to make the procedure the safest for the patient. In addition, anesthesia is given before the puncture. The doctor fully advises on what position the patient should be in.
If we talk about contraindications, then these include even slight suspicions of brain dislocation.
Brain puncture is not a dangerous procedure. It is carried out to detect abscesses in the brain. However, during brain puncture Complications are also possible. This is an infection in the brain; vascular damage; penetration of pus into the ventricles of the brain.
How to avoid complications?
In order not to harm human health, it is necessary to follow the following rules during the procedure:
Mandatory disinfection and treatment of the dura mater of the brain, first with peroxide, then with iodine;In order not to injure the vessels, a special needle with a blunt end is used for puncture;
The puncture must be carried out at a certain depth (maximum 4 centimeters), this will not allow pus to penetrate into the lateral ventricles brain
For the procedure, you need to prepare two needles in case one needle becomes clogged with brain tissue during the puncture. The needle should be wide. Not just any needle will be able to suck out pus from an abscess; a special needle with a mandrel is well suited for this.
Technique of the procedure
It is best to start the puncture in the area of the brain where the formation of abscesses is most likely:
In the lower part of the frontal lobe;In the lower part of the temporal lobe;
Above the tympanic space;
Above the mastoid process.
When performing a puncture in the frontal lobe, the doctor directs the needle to the side, up and back. During a puncture in the temporal lobe, the needle must go up, back and forward. If there is an abscess in the brain area, the contents are easily drained through a needle. For research it is also carried out spinal tap. It is carried out in following cases:
Brain injuries;Meningitis;
Spinal cord injuries;
Vascular diseases;
Cancerous brain tumors;
Dropsy of the brain.
The patient must inform the doctor whether he is taking any medications, whether there are allergies to anesthesia and any other medications, it is important for the doctor to know whether the patient has problems with blood clotting. The puncture cannot be performed in the following cases:
Pregnancy;Brain dislocation;
Hematomas inside the skull;
Brain abscess;
Traumatic shock;
Large blood loss;
Brain swelling;
Hypertension;
The presence of infectious and purulent formations in the back;
Bedsores in the lumbar region;
Brain injuries.
During the procedure, the patient should lie on his left side. Before the procedure, the patient must go to the toilet. The back must be strongly bent in an arc. The doctor inserts a needle between the vertebrae of the lower back and into the spinal canal. Using a syringe and a special needle, a small amount of fluid is taken from the spinal cord for testing or medications are administered. When examining a liquid, attention is paid to its color, transparency, composition, glucose and protein levels. At infectious diseases sowing is done.
After brain puncture
After the procedure, you may experience following symptoms:
Headache;Nausea;
Pain in the back;
Sometimes there is vomiting;
Convulsions;
Fainting;
Impaired cardiovascular activity;
Breathing problems.
It is very important to carry out this procedure correct, since errors during the puncture process and after it may cause serious complications. Very important correct position patient, precise selection of the area where the procedure will be performed. After the puncture, it is necessary to thoroughly clean the area where the puncture was made and apply a sterile bandage. During the procedure, the patient should not feel pain or discomfort. It is possible that he will feel the needle going under the skin and between the vertebrae, but this sensation should not be accompanied by pain. Our clinic specialists will perform a brain puncture effectively and painlessly. Come to our clinic and don’t be afraid of complications!
Spinal puncture, or lumbar puncture, is often used in neurology.
There are many diseases for which the final diagnosis is made only after a lumbar puncture and analysis of the resulting material (cerebrospinal fluid).
Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.
The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any medications have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .
Meningitis, encephalitis, and hemorrhages in the subarachnoid space of various etiologies require a lumbar puncture. The study is effective for confirming multiple sclerosis, polyneuropathies (defeat peripheral nerves) and neuroleukemia (blood cancer).
Lumbar puncture - indications for research
- Collection of cerebrospinal fluid (cerebrospinal fluid) for laboratory research.
- Conducting a more gentle spinal anesthesia before surgical interventions.
- Pain relief during difficult labor to prevent painful shock.
- To measure cerebrospinal fluid pressure.
- Performing in-depth studies: cisternography and myelography.
- Administration of necessary medications.
Preparing the patient for manipulation
Medical staff will explain the rules for the upcoming manipulation. Introduces everyone possible risks during the puncture and subsequent complications.
Preparation for puncture includes the following steps:
- The patient provides written consent for the puncture.
- Preliminary laboratory examination(blood sampling) to assess the quality of the kidneys, liver, and coagulation system.
- An anamnesis of the disease is collected. Recent and chronic processes are monitored.
- Be sure to tell your doctor about any existing allergic reactions- for novocaine, lidocaine, iodine, alcohol, drugs used during anesthesia, contrast agents.
- It is prohibited to take blood thinners (aspirin, lospirin, heparin, warfarin, aspecard, etc.). And non-steroidal anti-inflammatory and pain-relieving drugs.
- Last meal no later than twelve hours before the planned manipulation.
- Women should report even suspected pregnancy, because during the procedure there may be a need for x-ray examination, and this is bad for the development of the fetus at any time.
- Take medications in the morning strictly as recommended by the doctor.
- Presence of relatives.
If this study is performed on a child, the presence of the mother or father is allowed, but an agreement must be made with the doctor in advance.
Lumbar puncture technique
- The back area is treated with antiseptic soap.
- Disinfection with iodine or alcohol.
- Around surgical field a sterile napkin is applied.
- Treating the puncture site with an antiseptic.
- The patient is placed on a previously disinfected couch in the “embryo” position. Legs bent at the knees are pressed to the stomach, and the head is pressed to the chest.
- The surgical field is processed using alcohol solution Yoda.
- Novocaine is injected subcutaneously to local anesthesia punctured area.
- The needle is inserted between the third and fourth, or fourth and fifth spinous processes of the spinal column.
- If the procedure is performed correctly, both participants, the doctor and the patient, will feel the effect of the needle “falling through” as a result of its passage into the dura mater.
- Cerebrospinal fluid begins to leak after the mandrin is removed. If there are no deviations, the cerebrospinal fluid is clear and comes out in drops.
- A special pressure gauge measures pressure.
- After completing all planned manipulations, the needle is removed and its entry point is sealed with a sterile pad. In total, the process takes about forty-five minutes.
- Strict bed rest for eighteen hours.
- The doctor recommends painkillers to eliminate the consequences of the puncture ( headache and pain at the point where the needle enters).
The patient will be able to lead his previous lifestyle only after the permission of the treating doctor.
Video
Contraindications to the diagnostic procedure
There are contraindications for harmless examinations.
Puncture is prohibited:
- In case of brain dislocation, even if the diagnosis is not confirmed, but suspected. If the cerebrospinal fluid pressure is reduced in some areas and increased in others, it is not possible to exclude the phenomenon of herniation, which will inevitably lead to the death of the patient. In the history of medicine, there was a fatal case right on the table, during a diagnostic puncture.
- If at the puncture site there is skin or soft tissues infectious foci were identified. The risk of infection in the spinal canal is high.
The procedure is done with caution if:
- The patient is ill with thrombocytopenia.
- There are abnormalities in the blood coagulation system (high risk of bleeding). Preparation is necessary: abolition of thinning agents, platelet mass, frozen plasma. The doctor will give recommendations after performing the necessary examinations.
Interpretation of the results of the study of cerebrospinal fluid
Normally, cerebrospinal fluid resembles distilled water, colorless and transparent.
But when various diseases its color and consistency change, which indicates the presence of a malfunction in the body.
Eg:
- Greenish tint, characteristic of purulent meningitis or brain abscess.
- After injury or hemorrhage, its color turns red due to the presence of erythrocytes (red blood cells).
- Gray or gray-green liquor comes from large quantity microorganisms and leukocytes that try to cope with the infection.
- Brown color is rare and is the result of a ruptured cyst in the cerebrospinal fluid pathway.
- The yellow or yellow-brown color appears as a result of the breakdown of hemoglobin or the use of medicinal groups.
- Not mature or deformed, cancer cells indicate malignant oncological processes.
What are the consequences of puncture?
- One of the most common consequences resulting from this procedure is headache.
Begins between twelve and 20 four hours from the moment the procedure is completed.
Its duration ranges from a couple of days to fourteen days. The pain tends to decrease in intensity in a horizontal position of the body and increase in a vertical position.
- Bleeding occurs especially often when taking anticoagulants.
- Various types of hematoma.
- Needle injury intervertebral disc or nerve roots.
- When skin particles enter the cerebrospinal fluid, tumors of the spinal canal are formed.
- Introduction into the spinal space of drugs, contrast, antibacterial agents, entails a change in the composition of the cerebrospinal fluid. Myelitis, arachnoiditis or radiculitis may develop.
- Miscarriages are common in the first trimester of pregnancy.
The risks and benefits of performing a lumbar puncture are carefully considered and decided after all possible studies have been performed.
Specifically taking into account clinical manifestations for every patient. The final decision rests with the patient or his relatives. In the days of MRI and CT, this manipulation began to be used less frequently. But for some diseases it is indispensable.
Spinal puncture needles
Different needles are used for puncture. They have different tip sharpness and cut shape. By choosing the optimal parameters for a specific procedure, the holes in the dura mater are made neat, which helps to avoid a number of complications.
The most common types of needles:
- The most common type of spinal needle is Quincke. They have a particularly sharp edge. It is used to carefully make a hole thanks to the beveled tip.
- In the needles of Whitacre and Green distal form tips. This allows the fibers of the hard material to move apart meninges. The liquor flows through a hole of much smaller diameter.
- Sprott needles are used for puncture, but less frequently compared to other types. They have a conical tip and a large side opening. They are more often used for pain relief during childbirth.
For the production of puncture needles in the European Union they use stainless steel. The good thing about the material is that during the procedure the risk of needle breakage or bending is reduced. If the patient excess weight, then he will need an extra long needle for the procedure. In terms of strength, it does not differ from all other types.
If a disease is suspected, a puncture is performed
This procedure is carried out for both diagnostic and therapeutic purposes.
A spinal tap is performed for diagnosis in the following situations:
- To measure liquor pressure;
- To study the subarachnoid space of the spinal cord;
- To determine whether an infection is present in it;
- For studying cerebrospinal fluid.
IN medicinal purposes the procedure is carried out in the following situations:
- To remove excess cerebrospinal fluid that has accumulated in the cerebrospinal fluid;
- To withdraw funds remaining after chemotherapy or antibacterial drugs.
Indications are divided into 2 types:
- Absolute.
- Relative.
In the first case, the procedure is carried out based on the patient’s condition. In the second case, the final decision on the advisability of this procedure is made by the doctor.
The procedure is performed when the patient:
- Various infectious diseases;
- Hemorrhage;
- Malignant neoplasms.
The first type of indication includes finding out the reasons for the leakage of cerebrospinal fluid, for which dyes or radiopaque substances are administered.
TO relative indications include:
- Inflammatory polyneuropathy;
- Fever of unknown origin;
- Demyelinating diseases, such as multiple sclerosis;
- Systemic diseases connective tissue, for example lupus erythematosus.
Cost of a spinal tap
The price of the procedure depends on:
- The nature of the puncture.
In Moscow clinics the price ranges from 1,420 rubles to 5,400.
Not only there are special instructions and requirements for the procedure. After the puncture is performed, doctors advise following special instructions.
3 tips for a patient who has undergone this procedure:
- Be sure to observe bed rest. This will minimize the likelihood of cerebrospinal fluid leaking through the puncture hole.
- Stay in a horizontal position for about 3 hours after the puncture is completed to alleviate the patient’s condition if he experiences some pain.
- It is strictly forbidden to lift heavy objects in order to prevent the development of complications after the procedure.
If you follow the described rules, there will be no complications. In case of even the slightest discomfort, you should immediately consult a doctor.
3 tips for caring for a patient who has undergone a puncture:
- Once the procedure is completed, the patient is prescribed bed rest for 5 days. The time can be reduced to 3 days if drugs are injected into the subarachnoid area.
- Provide the patient with a horizontal position and place him on his stomach. Create a calm and quiet environment for him.
- Make sure he drinks plenty of fluids at room temperature.
If necessary, administer a plasma substitute intravenously. Before doing this, consult your doctor about the advisability.
An urgent consultation with a doctor will be required if the patient experiences at least one of the symptoms described below:
- Chills;
- Numbness;
- Fever;
- Feeling of tightness in the neck area;
- Discharge from the puncture site.
General opinion of those who have had a spinal tap
There are patients who, for health reasons, had to undergo more than one such operation. They testify that she is nothing terrible. But they note that the most important thing when performing a puncture is to get to a good specialist. They are sure that if the needle is inserted incorrectly, you can remain disabled for life.
Patients who underwent the procedure several times note that no side effects were observed. Sometimes there were minor headaches, but this happened rarely. If you want to completely eliminate the occurrence of pain during puncture, they advise asking the doctor to use a needle of a smaller diameter. In these situations, you do not feel pain, and the likelihood of developing complications is reduced.
Some patients compare the procedure to an intragluteal injection because the sensation is similar. There is nothing scary about the procedure itself. For many, the preparation process itself is more exciting.
A month after the procedure, patients feel great. This condition is observed if everything went correctly. They do not notice any special sensations, other than those that are characteristic of a regular injection. Sometimes patients observed an unexpected sensation, similar to a blow, which was concentrated in the knee area. After completing the procedure, this completely disappeared. Some patients say that there was a feeling that everything was not happening to them. After the procedure was completed, the anesthesia was released evenly from top to bottom.
Brain puncture is not a dangerous procedure. It is carried out to detect abscesses in the brain. However, during brain puncture Complications are also possible. This is an infection in the brain; vascular damage; penetration of pus into the ventricles of the brain.
In order not to harm human health, it is necessary to follow the following rules during the procedure:
Mandatory disinfection and treatment of the dura mater of the brain, first with peroxide, then with iodine;
In order not to injure the vessels, a special needle with a blunt end is used for puncture;
The puncture must be carried out at a certain depth (maximum 4 centimeters), this will not allow pus to penetrate into the lateral ventricles of the brain.
For the procedure, you need to prepare two needles in case one needle becomes clogged with brain tissue during the puncture. The needle should be wide. Not just any needle will be able to suck out pus from an abscess; a special needle with a mandrel is well suited for this.
Technique of the procedure
It is best to start the puncture in the area of the brain where the formation of abscesses is most likely:
In the lower part of the frontal lobe;
In the lower part of the temporal lobe;
Above the tympanic space;
Above the mastoid process.
When performing a puncture in the frontal lobe, the doctor directs the needle to the side, up and back. During a puncture in the temporal lobe, the needle must go up, back and forward. If there is an abscess in the brain area, the contents are easily drained through a needle. A spinal tap is also performed for research. It is carried out in the following cases:
Brain injuries;
Meningitis;
Spinal cord injuries;
Vascular diseases;
Cancerous brain tumors;
Dropsy of the brain.
The patient must inform the doctor whether he is taking any medications, whether he is allergic to anesthesia and any other medications; it is important for the doctor to know whether the patient has problems with blood clotting. The puncture cannot be performed in the following cases:
Pregnancy;
Brain dislocation;
Hematomas inside the skull;
Brain abscess;
Traumatic shock;
Large blood loss;
Brain swelling;
Hypertension;
The presence of infectious and purulent formations in the back;
Bedsores in the lumbar region;
Brain injuries.
During the procedure, the patient should lie on his left side. Before the procedure, the patient must go to the toilet. The back must be strongly bent in an arc. The doctor inserts a needle between the vertebrae of the lower back and into the spinal canal. Using a syringe and a special needle, a small amount of fluid is taken from the spinal cord for testing or medications are administered. When examining a liquid, attention is paid to its color, transparency, composition, glucose and protein levels. In case of infectious diseases, culture is performed.
After brain puncture
After the procedure, the following symptoms may be observed:
Headache;
Nausea;
Pain in the back;
Sometimes there is vomiting;
Convulsions;
Fainting;
Impaired cardiovascular activity;
Breathing problems.
It is very important to carry out this procedure correctly, since serious complications can arise if errors are made during the puncture process and after it. The correct position of the patient and the exact choice of the area where the procedure will be performed are very important. After the puncture, it is necessary to thoroughly clean the area where the puncture was made and apply a sterile bandage. During the procedure, the patient should not feel pain or discomfort. It is possible that he will feel the needle going under the skin and between the vertebrae, but this sensation should not be accompanied by pain. Our clinic specialists will perform a brain puncture effectively and painlessly. Come to our clinic and don’t be afraid of complications!
Neurology belongs to one of the complex branches of medicine. As science and technology develop, more and more new methods for studying the nervous system appear. One of the most informative procedures in the study of diseases of the nervous system is brain puncture. However, this research also carries a number of dangers.
What is a puncture? This is an invasive study of the brain in which a needle is inserted into the cavity of the ventricles of the brain for diagnostic or therapeutic purposes:
- For diagnostic purposes, a ventricular puncture is performed to collect cerebrospinal fluid contained in the ventricular system of the brain for further study.
- Therapeutic puncture of the ventricles of the brain is performed to urgently unload the ventricular system and reduce intracranial pressure; in rare cases, it is used to introduce medications into the ventricular cavity.
Sometimes a contrast agent is injected into the ventricular cavity to perform ventriculography.
The puncture is performed for head injuries, inflammatory diseases of the nervous system, disorders of liquorodynamics and many other diseases of the brain.
The only contraindication for ventricular puncture is bilateral tumor formation of the ventricles of the brain.
Based on the anatomical structure of the brain, there are several possible puncture options. The anterior, posterior and inferior horns of the lateral ventricles can be punctured. Most often, the anterior and posterior horns are punctured, while the lower ones are punctured if the previous puncture was not successful. The puncture site is chosen based on the pathogenic process, anatomical features and goals set by the neurosurgeon.
Before the puncture, the patient is prepared in advance for the procedure. On the evening before the study, a cleansing enema is performed, and the hair is shaved bald. On the day of the puncture, the patient should not eat or drink. Ventricular puncture is performed under local anesthesia. If the patient does not have an allergic reaction, use a 2% solution of novocaine. In any case, the novocaine test is repeated before the procedure. If the doctor has doubts about an allergy to the drug, it is replaced with another anesthetic.
Ventricular puncture of the anterior horn of the lateral ventricle is carried out in the following order:
- position the patient lying on his back, face up; if a puncture is performed on a patient with a suspected tumor in the brain, he is placed on the healthy side;
- the patient's head is brought slightly towards the chest;
- the neurosurgeon treats the scalp twice with iodine solution;
- Having outlined a line that runs parallel to the sagittal suture through the Kocher point, treat it with a 1% solution of brilliant green. The surgical site is then covered with a sterile drape.
Kocher's point is a point on the scalp, which is located 2 cm anteriorly and 2 cm outward from the intersection of the coronal and sagittal sutures. It is determined by palpation.
- At the site of the intended incision, local anesthesia is performed and a novocaine solution is injected;
- the skin is cut with a scalpel, a trepanation window is cut into the bone;
- The dura mater is carefully incised crosswise. Bleeding is most often stopped by rubbing wax into the bone, but electrocoagulation is more effective;
- a special brain cannula is inserted into the brain to a depth of 3 to 6 cm parallel to a figuratively drawn line. When the neurosurgeon punctures the wall of the lateral ventricle, he feels a slight dip.
- A yellowish liquid begins to ooze from the cannula - this is cerebrospinal fluid. Once the neurosurgeon is convinced that he is in the ventricular cavity, the needle is securely fixed. The volume and speed of the cerebrospinal fluid being pumped out is regulated with a special device - a mandrel.
It is very important that the liquor flows out slowly, in drops. If the pressure in the ventricular cavity is high, the cerebrospinal fluid spurts out, this should not be allowed. Rapid ventricular emptying is fraught with neurological consequences for the patient. The liquid is released drop by drop, the optimal level of pressure in the ventricle is considered when a “pulsating drop” is reached. For the study, 3-5 ml of cerebrospinal fluid is taken.
It is worth paying special attention to the fact that in parallel with the preparation of the room for the puncture, a large operating room is also being prepared, since there is always a danger of air getting into the ventricle, a puncture that is too deep, or damage to the blood vessel. If one of these complications is suspected during the puncture, the patient undergoes open brain surgery.
In addition to this method, there are several other options for accessing the anterior horn of the lateral ventricles: according to Dogliotti and according to Geimanovich. Both of these options are more often used in pediatric surgery. The Dogliotti method involves penetration into the ventricles of the brain through the orbit, and Geimanovich proposed puncture through the lower portion of the temporal bone.
With the Dogliotti and Geimarovich access, the puncture can be performed multiple times, which cannot be done with the standard type of access.
For children under one year of age, the puncture is performed through an open large fontanel, and there is no need to cut the skin. However, in this case, there is a risk of fistula formation; for prevention, before the puncture, the skin is moved away from the injection site.
Ventricular puncture of the posterior horn
When performing this type of puncture, the following actions are performed:
- the patient lies on his stomach face down. The head is fixed so that the sagittal suture is clearly in the midplane;
- the preparation of the surgical field is the same as when puncturing the anterior horn of the lateral ventricle: the head is treated with iodine solution, covered with sterile napkins and a sheet;
- the incision is made parallel to the sagittal suture. The cut should be made in such a way that the Dandy point is exactly in the middle. For this type of ventriculopuncture, a No. 18 needle is used.
- the needle is inserted at an angle so that the tip is directed to the outer-superior edge of the orbit. The depth of penetration into the brain is 5-7 cm. In children with severe hydrocephalus, the depth of penetration is much less and barely reaches 3.5 cm.
Ventriculopuncture of the inferior horn
The technique for performing this type of brain puncture is not much different from the previous two. The patient is placed on his side, the surgical field is half of the head along with the auricle. The incision is made 3.5 cm above and 3 cm posterior to the external auditory canal. Then a section of bone is also cut out, the dura mater is dissected and a puncture needle is inserted. The maximum immersion depth of the needle is 4 cm, the direction is to the upper edge of the auricle of the opposite side.
Possible complications
Puncture of the lateral ventricles of the brain, like any other operation, is fraught with a number of dangers. The most common complications are:
- When penetrating the cranial cavity and then cutting the dura mater, bleeding often occurs, but it is not always possible to immediately notice and eliminate it, which can result in hematomas.
- Damage to blood vessels in the brain.
- With a significant outflow of cerebrospinal fluid, there is a high risk of displacement of brain structures.
- Brain swelling.
Before performing the procedure, the neurosurgeon takes into account all possible risks.
Loading...