5 However patients are exposed to ionizing radiation during the procedure and obesity by itself is a predisposing factor for an increased procedure-associated radiation dose, as proved with interventional cardiology.
LP performed under fluoroscopic guidance can be less traumatic, therefore having a decreased likelihood of spurious false-positive results of hemorrhage and hence avoiding subsequent investigations such as CTA and conventional angiography. 4įluoroscopic-guided lumbar puncture (FGLP) is an effective alternative to bedside LP in patients with challenging body habitus. The LP technique is also used to access the CSF space to allow instillation of chemotherapeutic agents, antispasmodics, and contrast media. 3 Valid indications for CSF sampling also include suspected CNS infection, demyelinating disease, and CNS malignancy. The American College of Radiology (ACR) Appropriateness Criteria include LP as a recommended procedure in the setting of negative findings on CT head in the clinical scenario of thunderclap headache when subarachnoid hemorrhage is suspected. 2ĬSF analysis is a valuable diagnostic tool. 1 However, surface landmark identification of underlying structures has been shown to be accurate only 30% of the time and can be difficult in the obese patient. The diagnostic LP is typically performed at the bedside by using surface landmark guidance, as first described by Quincke in 1891. This procedure involves the percutaneous introduction of a needle below the termination level of the spinal cord, passing through the dura mater of the spinal canal and entering the subarachnoid space. Lumbar puncture (LP) is an invasive technique that accesses the restricted compartment of the subarachnoid space to sample CSF. ABBREVIATIONS: ACR American College of Radiology BMI body mass index FGLP fluoroscopic-guided lumbar puncture IIH idiopathic intracranial hypertension LP lumbar puncture
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