[Lateral cervical puncture for myelography and cerebrospinal fluid collection: technical note]

A new method of subarachnoid puncture for clinical diagnosis and treatment: lateral atlanto-occipital space puncture

OBJECTIVE

Lumbar puncture may not be suitable for some patients needing subarachnoid puncture, while lateral C1–2 puncture and cisterna magna puncture have safety concerns. This study investigated lateral atlanto-occipital space puncture (also called lateral cisterna magna puncture) in patients who needed subarachnoid puncture for clinical diagnosis or treatment. The purpose of the study was to provide information on the complications and feasibility of this technique and its potential advantages over traditional subarachnoid puncture techniques.

METHODS

In total, 1008 lateral atlanto-occipital space puncture procedures performed in 667 patients were retrospectively analyzed. The success rate and complications were also analyzed. All patients were followed up for 1 week after puncture.

RESULTS

Of 1008 lateral atlanto-occipital space punctures, 991 succeeded and 17 failed (1.7%). Fifteen patients (2.25%) reported pain in the ipsilateral external auditory canal or deep soft tissue, 32 patients (4.80%) had a transient increase in blood pressure, and 1 patient (0.15%) had intracranial hypotension after the puncture. These complications resolved fully in all cases. There were no serious complications.

CONCLUSIONS

Lateral atlanto-occipital space puncture is a feasible technique of subarachnoid puncture for clinical diagnosis and treatment. It is associated with a lower rate of complications than lateral C1–2 puncture or traditional (suboccipital) cisterna magna puncture. It may have potential in the neurological diagnostic and treatment fields.

[Pharyngeal pain during lateral suboccipital puncture]

Oropharyngeal pain was referred by five fully conscious and collaborative patients during lateral suboccipital puncture (LSP) of the cisterna magna, performed for myelography and/or cerebrospinal fluid collection. The anastomotic connections between the lower cranial nerves, the sympathetic nerves and the upper cervical spinal nerves are reviewed, with emphasis on the relationship between the first cervical nerve (C1), the superior cervical ganglion of the sympathetic trunk, and the spinal accessory nerve (nerve XI), and their central connections. The authors conclude that pharyngeal pain during LSP is provoked by the stimulation of afferent visceral fibers of C1, or of the gray communicating branches of the superior cervical ganglion to C1.