Suboccipital puncture
Encyclopedia
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
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
(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
External occipital protuberance
Near the middle of the occipital squama is the external occipital protuberance, and extending lateralward from it on either side is the superior nuchal line, and above this the faintly marked highest nuchal line.It is less pronounced in females....
into the cisterna magna
Cisterna magna
The cisterna magna is one of three principal openings in the subarachnoid space between the arachnoid and pia mater layers of the meninges surrounding the brain. The openings are collectively referred to as cisterns. The cisterna magna is located between the cerebellum and the dorsal surface of...
and is an alternative to lumbar puncture
Lumbar puncture
A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
. Indications for its use are limited. Subarachnoid hemorrhage
Subarachnoid hemorrhage
A subarachnoid hemorrhage , or subarachnoid haemorrhage in British English, is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain...
and direct puncture of brain tissue are the most common major complications. Fluoroscopic
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
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