Suboccipital puncture

Suboccipital puncture
Suboccipital puncture
Intervention
ICD-9-CM 01.0

A suboccipital puncture or cisternal puncture is a diagnostic procedure that can be performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or rarely to relieve increased intracranial pressure. It is done by inserting a needle through the skin below the external occipital protuberance into the cisterna magna and is an alternative to lumbar puncture. Indications for its use are limited. Subarachnoid hemorrhage and direct puncture of brain tissue are the most common major complications. Fluoroscopic guidance decreases the risk for complications. The use of this procedure in humans was first described by Ayer in 1920.

This is an exceedingly rare procedure. When CSF cannot be obtained from the lumbar space (and when its analysis is considered critical to treatment), a cisternal tap may be required. The needle is placed in the midline, passing just under the occipital bone, into the (usually large) cisterna magna (Fig. 23-2). This is technically fairly easy; however, if the needle is advanced too far it can enter the medulla, sometimes causing sudden respiratory arrest and death. The test should therefore be carried out only by experienced physicians (usually neurosurgeons or neurologists). An alternative route that may be used by neurosurgeons and neuroradiologists is lateral to C-1 with penetration through the large C-1 intervertebral hiatus.

The cisternal tap may be used in myelography when the upper margin of a spinal block needs to be defined, however, magnetic resonance imaging (MRI), has become the procedure of choice for defining the upper and lower limits of spinal cord or spinal cord compressing lesions. It is necessary at times in the intrathecal administration of irritating medications, such as amphotericin B. Medications are diluted more rapidly in the larger and more rapidly circulating volume of cisterna magna than in the smaller lumbar sac


Wikimedia Foundation. 2010.

Игры ⚽ Поможем написать реферат

Look at other dictionaries:

  • suboccipital puncture — cisternal p …   Medical dictionary

  • Lumbar puncture — Intervention A patient undergoes a lumbar puncture at the hands of a neurologist. The reddish brown swirls on the patient s back are tincture of iodine (an antiseptic). ICD 9 CM …   Wikipedia

  • cisternal puncture — puncture of the cisterna cerebellomedullaris through the posterior atlanto occipital membrane for the purpose of withdrawing cerebrospinal fluid; called also intracisternal p. and suboccipital p …   Medical dictionary

  • Surgery — This article is about the medical specialty. For other uses, see Surgery (disambiguation). A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. Surgery (from the Greek …   Wikipedia

  • Nerve block — Intervention ICD 9 CM 04.81 MeSH …   Wikipedia

  • Neuroimaging — Para sagittal MRI of the head in a patient with benign familial macrocephaly. 3 D MRI o …   Wikipedia

  • Clinical prediction rule — A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome.[1] Physicians… …   Wikipedia

  • Neurosurgery — Occupation Activity sectors Surgery Description Education required Doctor of Medicine, Doctor of Osteopathic Med …   Wikipedia

  • Nervous system — Nerve redirects here. For other uses, see Nerve (disambiguation). This article is about the nervous system. For parts of the nervous system commonly called nerves, see Peripheral nerve. Nervous system The Human N …   Wikipedia

  • Bilateral cingulotomy — Intervention ICD 9 CM 01.32 Bilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of obsessive compulsive disorder …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”