Cervical (suboccipital) puncture

Cervical or suboccipital puncture can be used in the presence of contraindications to the usual lumbar puncture (for example, in the infectious process in the lumbar region).

Complications

Lumbar puncture rarely causes serious complications. Transient dysfunctions, on the contrary, are very frequent. According to various data, post-puncture headache occurs in 1-3 of 10 patients. The pain is usually localized in the frontal region and, as a rule, disappears in the supine position. Often there is pain in the neck. Sometimes, in the vertical position, nausea, vomiting, ringing in the ears, stuffiness of the ears, cold sweat also occur. Pain can occur after 15 minutes, sometimes 4 days later, but more often within 12-24 hours after a puncture. Postural headache usually lasts 4-7 days, but can pass earlier or remain for 2 weeks. Apparently, the headache arises from the tension of pain-sensitive cerebral membranes and vessels, due to the flow of cerebro-spinal fluid through the hole from the puncture in the hard shell of the spinal cord and the development of cerebrospinal fluid. Significantly more often headaches occur after the use of thick or blunt puncture needles. When using very thin needles, post-puncture headache occurs very rarely, however, the intake of fluid in this case is very prolonged. Since the basis of post-puncture headache is intracranial hypotension, treatment is limited to compliance with bed rest, oral hydration (2-4 liters per day) and the administration of 400-600 mg of sodium caffeine-benzoate subcutaneously or intramuscularly.

Local back pain may be due to irritation of the spine, traumatization of the periosteum, local accumulation of blood or fluid, slight damage to the fibrous ring or a true disc herniation. Infection, an extremely rare complication of lumbar puncture, is a consequence of a violation of asepsis or develops when the needle passes through infected tissues. Meningitis can occur within 12 hours after a puncture. Equally rare are less severe infections, such as an epidural abscess or osteomyelitis of the vertebral body. The most formidable complications of puncture are the tentorial and cerebellar hernias. The wedge occurs at the block of liquor circulation, which prevents rapid equalization of pressure differences in the subarachnoid space during the extraction of the cerebro-spinal fluid. Especially high risk of wedging with volumetric processes in the posterior cranial fossa. Although local moderate bleeding during puncture passes unnoticed, it can cause difficulties in interpreting the results of subsequent puncture due to residual xanthrochromia. Spinal subdural hematoma compressing the ponytail is one of the most rare complications of puncture. Unjustified difficulties in interpretation are caused by another casuistic complication of the puncture - diplopia, associated with damage to the abducent nerve (IV) as a result of its tension over the bone formations of the base of the skull, since the flow of fluid from the lumbar cistern displaces the intracranial structures down and back. The most unusual late complication is the formation of a dermoid tumor in the subarachnoid space from the epidermal cells recorded during puncture.

[1], [2], [3], [4]