ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Fluoroscopic guidance decreases the risk of post-lumbar puncture headache in patients with idiopathic intracranial hypertension.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInformation derived from lumbar puncture (LP) remains fundamental in the diagnosis of idiopathic intracranial hypertension (IIH). However, almost all patients with IIH are obese, rendering LPs technically difficult. The number of attempts required to achieve success and the likelihood of post-LP headache due to cerebrospinal fluid (CSF) leak has not been well characterized in this specific patient population or by LP modality.
methodsWe conducted a retrospective chart review of IIH patients seen at a single neuro-ophthalmology clinic who underwent LP, either guided by conventional anatomic landmarks or via fluoroscopy. Chi-squared analysis was performed to assess differences in the likelihood of post-LP CSF leak by LP method. Unpaired t-tests were performed to assess between differences in the number of attempts required, BMI, and opening pressure.
results49 patients underwent 74 LPs. 31 (42%) were performed at the bedside, while 43 (58%) were performed fluoroscopically. Incidence of post-LP CSF leak was 14% in patients who underwent fluoroscopically-guided LPs and 45% in patients receiving bedside LPs (p-value = .0029). 8 bedside LPs (26%) required multiple attempts to complete, while only 1 fluoroscopically guided procedure required more than 1 attempt (2%).
conclusionFluoroscopically-guided LPs required fewer attempts and were less likely to be complicated by CSF leak compared to bedside LPs. Body mass index and opening pressure were not associated with the risk of a post-LP CSF leak. The information derived from this study may help to avoid excess time, cost, and morbidity in the evaluation of patients with suspected IIH.
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