Controlled lumbar drainage in pediatric XXXX .

@entity1 @entity2656 @entity2657 @entity428 @entity542 @entity1483 @entity772
A retrospective study of external lumbar subarachnoid drainage in 16 pediatric @entity1 with severe @entity542 is presented. All @entity1 had Glasgow @entity772 Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five @entity1 required surgical evacuation of focal mass lesions. All @entity1 manifested high intracranial pressures (ICPs) refractory to aggressive therapy, including hyperventilation, @entity1483 , @entity2656 , and in some cases, artificially induced barbiturate @entity772 . After lumbar drainage was instituted, 14 @entity1 had an abrupt and lasting decrease in @entity428 , obviating the need for continued medical management of @entity428 . In no @entity1 did transtentorial or cerebellar herniation occur as a result of lumbar drainage. It was also noted retrospectively that the @entity1 in this study had discernible basilar cisterns on computerized tomography scans. Fourteen @entity1 survived; eight made good recoveries, three are functional with disability, and three have severe disabilities. Two @entity1 died, most likely from uncontrolled @entity428 before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric @entity1 with severe @entity542 when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high @entity428 . Selected @entity1 with @entity428 , which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or @entity2657 , can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.
