Normal saline injection via lumbar puncture for the treatment of acute tonsillar herniation: a report of 45 cases.

Abstract

OBJECTIVE:

Current treatment of apnea attributable to acute tonsillar herniation often is inadequate. This study was undertaken to verify the clinical usefulness of normal saline injection via lumbar puncture for the treatment of apnea secondary to acute tonsillar herniation.

METHODS:

Between 1969 and 2009, 45 patients who had not regained spontaneous respiratory function after external ventricular drainage or removal of a supratentorial lesion via open craniotomy received an injection of normal saline via lumbar puncture. Patient data were retrospectively analyzed.

RESULTS:

Eleven of the 45 patients regained spontaneous breathing and recovered fully (24.4%). Sixteen patients regained spontaneous breathing but died later (35.6%), and 18 patients did not regain spontaneous respiration (40.0%). The overall rate of effectiveness of injected normal saline was therefore 60.0%.

CONCLUSION:

For patients with tonsillar hernia who did not regain spontaneous respiration after external ventricular drainage or removal of a supratentorial lesion, an aggressive approach may be considered. Injection of normal saline via lumbar puncture could improve outcome in some of these patients.

• Authors: Qinghu Meng, Lin Wei, Xingang Li, Gang Li, Xueyuan Heng, Chengwei Wang, Chang Fei, Qinglin Zhang
• Journal: World neurosurgery (World Neurosurg) Vol. 81 Issue 1 Pg. 173-6 (Jan 2014) ISSN: 1878-8769 [Electronic] United States
• PMID: 23041068 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014. Published by Elsevier Inc.

Chemical References

• Sodium Chloride

Topics

• Acute Disease
• Adolescent
• Apnea (drug therapy, therapy)
• Cerebellum (pathology)
• Cerebral Ventriculography
• Coma (etiology)
• Craniotomy
• Drainage
• Emergency Medical Services
• Encephalocele (complications, drug therapy, pathology)
• Female
• Glasgow Coma Scale
• Humans
• Intracranial Pressure (physiology)
• Male
• Medulla Oblongata (pathology)
• Neurosurgical Procedures
• Recovery of Function
• Sodium Chloride (administration & dosage, therapeutic use)
• Spinal Puncture (methods)
• Supratentorial Neoplasms (surgery)
• Treatment Outcome
• Unconsciousness
• Young Adult