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Lumbar Puncture. E.Fakharian, M.D Assistant Professor of Neurosurgery Kashan University of Medical Sciences <fakharian_e@kaums.ac.ir>. Lumbar Puncture. LP is an invasive procedure for obtaining CSF. First reports of CSF is in Edwin-Smith Surgical Papyrus written 3700 yrs ago.

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lumbar puncture

Lumbar Puncture

E.Fakharian, M.D

Assistant Professor of Neurosurgery

Kashan University of Medical Sciences

<fakharian_e@kaums.ac.ir>

lumbar puncture1
Lumbar Puncture
  • LP is an invasive procedure for obtaining CSF.
  • First reports of CSF is in Edwin-Smith Surgical Papyrus written 3700 yrs ago.
  • Hippocrates reported CSF presence in brain cavities, 4 centuries B.C.
  • Galen described ventricular cavities 2 centuries A.C.
  • In 1891 Heinrich Quincke, of Kiel, Germany, introduced this procedure as we know it today. His original intent was to help babies suffering from hydrocephalus by draining away excess fluid, but from the outset he was also interested in lumbar puncture's use as a diagnostic tool, & examined CSF for its pressure, sugar, protein, & cell count.
  • Widal introduced CSF cytological studies in 1901.
lumbar puncture3
LP for Dx

Infections, e.g. meningitis.

Demyelinating diseases, e.g., M.S.

High ICP, e.g., pseudotumor cerebri.

Bleeding, e.g., SAH.

Introducing contrast agent for Dx, e.g., DH,….

LP for RX

Infections, e.g. meningitis.

High ICP, e.g., pseudotumor cerebri.

Malignancies, e.g., leukemia.

Anesthesia

Others, e.g., CSF leakage.

Lumbar Puncture
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Complications

Low pressure H/A.

Hematoma.

Cerebral herniation.

Infections.

Neural injury.

LBP.

Contraindications

Infection or wound at the site of LP

Bleeding tendency.

Intracranial or intraspinal mass lesions.

Lumbar Puncture
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Procedure:

Sitting

Lying down

L2/L3 level downwards

Needle between 2 spinal processes

30* cephalad direction

Beveled tip direction depends to the aim of LP

Lumbar Puncture
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Lumbar Puncture

Quinke needles

Sprotte needle

Touhy needle