Post-dural puncture headache incidence after cerebrospinal fluid aspiration. A prospective observational study

Abstract Background: Post-dural puncture headache (PDPH) is an iatrogenic condition following lumbar puncture (LP). Incidence is variable and often associated with young females. Technical features of the procedure (i.e. needle gauge) have been investigated; however there is no investigation on the method of cerebrospinal fluid (CSF) collection. Objective: To investigate whether mild CSF aspiration is associated with increased PDPH in selected patients. Methods: 336 subjects were eligible to the study. Data on 237 patients from a tertiary neurology hospital who underwent diagnostic LP from February 2010 to December 2012 were analysed. Patient demographics, lumbar puncture method, CSF biochemical characteristics, opening pressures, and a follow-up inquire on PDPH occurrence were collected. CSF was collected either by allowing free flow or by mild aspiration. Results: The aspiration arm (n=163) was comprised of 55.8% females with mean age of 52(35‒69) years. Sex distribution was not different between the two arms (p=0.191). A significant larger amount of CSF was obtained in the aspiration arm (p=0.011). The incidence of PDPH in the aspiration arm was 16.5% versus 20.2% in the free flow arm, not statistically significant (p=0.489). No relevant associations emerged from the analyses in the subgroup aged <65 years. Conclusions: Aspiration of the CSF during LP was not associated with increased rates of PDPH compared to the standard method, particularly when larger amounts of CSF are required and ideal conditions are met. This is the first study looking into this matter, aiming to add safety to the procedure. Further randomized trials are required.

摘要 背景：硬脊膜穿刺后头痛（Post-dural puncture headache, PDPH）是腰椎穿刺（lumbar puncture, LP）术后发生的医源性并发症。其发病率存在波动，且常好发于年轻女性群体。目前已有研究探讨了该操作的技术细节（如穿刺针针号）对其的影响，但尚未有研究关注脑脊液（cerebrospinal fluid, CSF）采集方式的作用。研究目的：本研究旨在探讨在选定患者群体中，轻度负压抽吸脑脊液是否会增加硬脊膜穿刺后头痛的发生风险。研究方法：本研究共纳入336名符合入组标准的受试者，分析了2010年2月至2012年12月期间，某三级神经病学医院内237名接受诊断性腰椎穿刺患者的临床数据。收集的资料包括患者人口学特征、腰椎穿刺操作细节、脑脊液生化指标、开放压力，以及针对硬脊膜穿刺后头痛发生情况的随访问询。脑脊液采集方式分为自然引流法与轻度负压抽吸法两种。研究结果：负压抽吸组（n=163）中女性占比55.8%，平均年龄为52岁（四分位间距35~69岁）。两组受试者的性别分布无统计学差异（p=0.191）。负压抽吸组采集的脑脊液量显著多于自然引流组（p=0.011）。负压抽吸组硬脊膜穿刺后头痛的发生率为16.5%，自然引流组为20.2%，组间差异无统计学意义（p=0.489）。在年龄<65岁的亚组分析中，未发现相关关联。研究结论：与标准自然引流采集方式相比，腰椎穿刺术中采用负压抽吸脑脊液并未增加硬脊膜穿刺后头痛的发生风险，尤其在需要采集较多量脑脊液且操作条件理想的场景下。本研究为首个探讨该问题的相关研究，旨在为该操作增添安全性依据，未来仍需开展更多随机对照试验以进一步验证。