Ventricular puncture; is it a safe procedure?
Nakajima, S.; Sampei, T.; Mizuno, M.; Suzuki, A.; Yasui, N.
No Shinkei Geka. Neurological Surgery 20(4): 349-356
1992
ISSN/ISBN: 0301-2603 PMID: 1570055 Document Number: 396411
Four hundred and fifty patients underwent 755 ventricular punctures as a procedure for continuous ventricular drainage (CVD), or ventriculoperitoneal/ventriculoatrial shunt (shunt) between April, 1983 and March, 1990. In all patients, postoperative findings on CT scan and related clinical manifestations were studied. Of the total of 755 punctures in 100 cases (13.2%) some high density areas (HDA) (i.e. intracerebral hemorrhage) appeared on CT scans, and, of these, HDA larger than 3 cm in diameter (Type C) was seen in 12 cases (1.6%). On the other hand, some low density areas (LDA) appeared in 448 cases (59.3%), and, of these, an extensive LDA (Type C) was seen in 65 cases (8.6%). LDA on CT scan tended to improve gradually with time, and in one third of the cases it was undetectable one year after puncture. Nine percent of the LDA decreased in density, and they were regarded as areas of infarction or porencephalus. The factors considered to affect postoperative HDA were 1) old age, 2) puncture in the occipital region, 3) puncture in a previously damaged brain area, 4) repuncture using the same tract within a short interval from the previous puncture, 5) CVD. Conversely, factors that affected the LDA were 1) low age, 2) puncture in the occipital region, 3) puncture to normal, nondamaged brain, 4) puncture using a new tract. Ten out of 12 patients with large HDA (Type C) showed deterioration of consciousness level or epilepsy as an acute manifestation, and prolonged disturbance of consciousness. Mental change and/or homonymous hemianopia were seen in all surviving patients in the chronic phase. One patient who underwent puncture in the occipital region had postoperative homonymous hemianopia that was considered to be caused solely by the effect of the puncture. Also, many patients developed postoperative signs and symptoms that were supposed to be caused by the puncture but which actually had been obscured by the clinical manifestations of the original disease. Ventricular puncture is not a safe procedure and it should be considered only if another procedure such as spinal drainage or lumboperitoneal shunt is unavailable.