PRELIMINARY EXPERIENCE WITH CONTROLLED EXTERNAL LUMBAR DRAINAGE IN DIFFUSE PEDIATRIC HEAD-INJURY

Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. Within 72 h of admission, all children manifested high intracranial pressures (ICP) refractory to maximal therapy, including hyperventilation, furosemide, mannitol, and barbiturate coma. After the institution of lumbar drainage 3 of the 5 children had an abrupt and lasting decrease in ICP, obviating the need for continued barbiturates and hyperventilation. Three children survived, 2 of whom made good recoveries; 1 child is functional with disability. ICP varied passively with the height of the drainage bag in these surviving patients. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.