Suboccipital puncture

Indication

 * malformation in the area of ​​the lumbar spine
 * purulent affections in the lumbar region
 * suspected blockage of the spinal cord
 * repeated unsuccessful punctures in the lumbar region

Contraindication

 * suspected expansive process in the posterior cranial fossa
 * inflammatory skin changes in the injection area
 * Arnold-Chiari malformation
 * spondylitis a osteomyelitis in the injection area

Method
thumb|right|Trigonum suboccipitale (a. vertebralis)
 * the patient lies on the side with the knees drawn to the abdomen
 * aseptically prepare the puncture site, which is in the middle of the line connecting the protuberantia occipitalis with the processus spinosus epistrophei
 * after piercing the skin, the lumbar needle is inserted upwards to the os occipitale, moves along its edge to the membrana atlantooccipitalis, and after overcoming slight resistance, we pull out the stylet and collect a small amount of cerebrospinal fluid for examination
 * the procedure ends by inserting the mandrel into the needle, pulling it out, compressing the injection site and sterile covering

Complication

 * posterior cerebellar artery injury
 * bleeding from extradural plexuses
 * sudden death from bleeding into the cistern or IV. chambers

Source

 * HAVRÁNEK, Jiří: Subokcipitální punkce.

related articles

 * Cerebrospinal fluid examination