Objective:

LP is one of the most frequently used diagnostic modalities in neurology and neurosurgery. Post-LP headache (PLPH) is the most common complication of LP (10-32%). Epidural blood patch is a treatment to cure severe and prolonged PLPH.

Background:

PLPH is a common complication associated with cerebrospinal fluid (CSF) leakage after a LP. Usually, patients exhibit headaches with upright body positions. Various prophylactic and therapeutic treatments have been used to reduce and treat PLPH including keeping a supine position for four hours post-LP, caffeine supplementation, aggressive oral or intravenous (IV) hydration, and bed rest. However, the most effective treatment for moderate to severe PLPH is the epidural blood patch. This study investigates an improved LP procedure that reduces PLPH and epidural blood patch rates in brain cancer patients.

Design/Methods:

A retrospective review of medical records over 12 years (2011-2022) was performed in patients who had a LP from one physician (JZ). Modifications from standard procedure include: 1) no reposition of the stylet in the spinal needle prior to removing the needle at the end of the procedure, 2) using a 22-gauge cutting spinal needle. Patient data was collected from all accessible electronic medical records. Complications post-procedure were noted, and incidence rates were calculated.

Results:

Among 341 LPs performed on 192 patients, 12 incidences of PLPH (3.52%) were identified. Five additional patients presented with headaches, but LP-related classification was unclear (1.47%). Epidural blood patches were utilized in two cases of headaches out of 17 total cases (11.76%). However, only one of these two incidences was identified as PLPH treatment (8.33%, 1/12). No infection or hemorrhage was identified.

Conclusions:

The modified LP procedure is associated with reduced PLPH and epidural blood patch rates. The data suggests decreased CSF leakage from equalized pressure gradients that reduces dural tears. Further investigations are warranted to evaluate the modified procedure prospectively.