Pierce David B, Shivaram Giri, Koo Kevin S H, Shaw Dennis W W, Meyer Kirby F, Monroe Eric J
Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA, 98105, USA.
Pediatr Radiol. 2018 Jun;48(6):875-881. doi: 10.1007/s00247-018-4091-2. Epub 2018 Feb 3.
Disadvantages of fluoroscopically guided lumbar puncture include delivery of ionizing radiation and limited resolution of incompletely ossified posterior elements. Ultrasound (US) allows visualization of critical soft tissues and the cerebrospinal fluid (CSF) space without ionizing radiation.
To determine the technical success and safety of US-guided lumbar puncture in pediatric patients.
A retrospective review identified all patients referred to interventional radiology for lumbar puncture between June 2010 and June 2017. Patients who underwent lumbar puncture with fluoroscopic guidance alone were excluded. For the remaining procedures, technical success and procedural complications were assessed. Two hundred and one image-guided lumbar punctures in 161 patients were included. Eighty patients (43%) had previously failed landmark-based attempts.
One hundred ninety-six (97.5%) patients underwent lumbar puncture. Five procedures (2.5%) were not attempted after US assessment, either due to a paucity of CSF or unsafe window for needle placement. Technical success was achieved in 187 (95.4%) of lumbar punctures attempted with US guidance. One hundred seventy-seven (90.3%) were technically successful with US alone (age range: 2 days-15 years, weight range: 1.9-53.1 kg) and an additional 10 (5.1%) were successful with US-guided thecal access and subsequent fluoroscopic confirmation. Three (1.5%) cases were unsuccessful with US guidance but were subsequently successful with fluoroscopic guidance. Of the 80 previously failed landmark-based lumbar punctures, 77 (96.3%) were successful with US guidance alone. There were no reported complications.
US guidance is safe and effective for lumbar punctures and has specific advantages over fluoroscopy in pediatric patients.
荧光透视引导下腰椎穿刺的缺点包括电离辐射的暴露以及对未完全骨化的后部结构分辨率有限。超声（US）能够在不产生电离辐射的情况下可视化关键软组织和脑脊液（CSF）间隙。
确定超声引导下小儿腰椎穿刺的技术成功率和安全性。
一项回顾性研究纳入了2010年6月至2017年6月间所有因腰椎穿刺转诊至介入放射科的患者。仅接受荧光透视引导下腰椎穿刺的患者被排除。对于其余操作，评估技术成功率和操作并发症。纳入了161例患者的201次影像引导下腰椎穿刺。80例患者（43%）此前基于体表标志的穿刺尝试失败。
196例（97.5%）患者接受了腰椎穿刺。5例操作（2.5%）在超声评估后未进行，原因是脑脊液量少或穿刺针放置的安全窗口不佳。在超声引导下尝试的腰椎穿刺中，187例（95.4%）取得技术成功。177例（90.3%）仅使用超声技术成功（年龄范围：2天至15岁，体重范围：1.9至53.1千克），另有10例（5.1%）在超声引导下进入蛛网膜下腔并随后经荧光透视确认成功。3例（1.5%）在超声引导下未成功，但随后在荧光透视引导下成功。在80例此前基于体表标志的腰椎穿刺失败的患者中，77例（96.3%）仅在超声引导下成功。无并发症报告。
超声引导下腰椎穿刺安全有效，在小儿患者中相对于荧光透视具有特定优势。
