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Letter to the Editor: Pneumocephalus: Is the needle size significant?

Discussion. Pneumocephalus is defined by two mechanisms: a ball-valve and an inverted bottle concept.1 The ball-valve type implies positive pressure events, such as coughing or valsalva maneuvers, that prevent air escape. Tension pneumocephalus is included in this mechanism, causing a parenchymal mass effect. The inverted bottle theory includes a negative intracranial pressure gradient following cerebrospinal fluid drainage, relieved by air influx. A small pneumocephalus is usually sealed by blood clots or granulation, allowing spontaneous reabsorption and resolution.[1] Otherwise, the lateral positioning of a patient during spinal tap might create a lower intrathecal pressure with air being allowed into the subarachnoid space. Pneumocephalus also can develop when a stylet is reinserted into the needle before needle retraction, usually performed to minimize post-dural-puncture headache.[6] Pneumocephalus can be avoided by performing the LP in a sitting position, monitoring the amount of fluid drainage, carefully replacing the stylet to make sure the needle does not contain air, and instructing patients to briefly hold their breath and prevent making sudden movements during the procedure.[3] It is also important to consider needle size during a spinal tap. A smaller gauge makes a smaller dural perforation, causing less damage compared to larger ones; that also prevents cerebrospinal fluid leakage.[7,8] There is an inverse correlation between the needle gauge and post-dural-pun...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Assessment Tools CNS Infections Current Issue Letters to the Editor Neurologic Systems and Symptoms Neurology Stroke Traumatic Brain Injury epidural needle size Pneumocephalus spinal tap Source Type: research

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Source: World Neurosurgery - Category: Neurosurgery Authors: Tags: Letter to the Editor Source Type: research
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Source: Cardiovascular and Hematological Disorders Drug Targets - Category: Drugs & Pharmacology Tags: Cardiovasc Hematol Disord Drug Targets Source Type: research
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Source: Cardiovascular and Hematological Disorders Drug Targets - Category: Drugs & Pharmacology Tags: Cardiovasc Hematol Disord Drug Targets Source Type: research
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Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
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Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
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Source: Health News from Medical News Today - Category: Consumer Health News Tags: Diabetes Type 2 Source Type: news
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Source: Guardian Unlimited Science - Category: Science Authors: Tags: Diabetes Medical research Diets and dieting Life and style Society UK news Science Source Type: news
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Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
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Source: Artificial Cells, Nanomedicine and Biotechnology - Category: Biotechnology Tags: Artif Cells Nanomed Biotechnol Source Type: research
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Source: Guardian Unlimited Science - Category: Science Authors: Tags: Life and style Psychology Science Health & wellbeing Source Type: news
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