CONTROLLED LUMBAR DRAINAGE IN PEDIATRIC HEAD-INJURY

A retrospective study of external lumbar subarachnoid drainage in 16 p ediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required s urgical evacuation of focal mass lesions. All patients manifested high intracranial pressures (ICPs) refractory to aggressive therapy, inclu ding hyperventilation, furosemide, mannitol, and in some cases, artifi cially induced barbiturate coma. After lumbar drainage was instituted, 14 patients had an abrupt and lasting decrease in ICP, obviating the need for continued medical management of ICP. In no patient did transt entorial or cerebellar herniation occur as a result of lumbar drainage . It was also noted retrospectively that the patients in this study ha d discernible basilar cisterns on computerized tomography scans. Fourt een patients survived; eight made good recoveries, three are functiona l with disability, and three have severe disabilities. Two patients di ed, most likely from uncontrolled ICP before the lumbar drain was plac ed. It is concluded that controlled external lumbar subarachnoid drain age is a useful treatment for pediatric patients with severe head inju ry when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with el evated ICP, which may be a function of posttraumatic cerebrospinal flu id circulation disruption and/or white matter cerebral edema, can be t reated with this modality, which accesses the cisternal spaces untappe d by ventriculostomy.