Techniques and complications of external lumbar drainage for normal pressure hydrocephalus.

OBJECTIVE: To describe our system of external lumbar drainage for normal pressure hydrocephalus, detail its complications, and discuss changes made to that system with time.

METHODS: This is a retrospective analysis of lumbar drainage in 233 consecutive patients with symptoms treated at the Brigham and Women's Hospital, Boston, MA, from February 2002 to August 2006.

RESULTS: The lumbar drain was successfully placed at the bedside in 223 of 233 patients; fluoroscopic guidance was used in 10 cases. There were significant complications in 3.0% of patients, including symptomatic subdural or subarachnoid hemorrhage in 1.7%, meningitis in 0.8%, and retained catheter in 0.4%. Another 5.2% of patients had minor problems, including nerve root irritation in 2.6%, low-pressure headache substantial enough to warrant premature removal of the drain in 1.7%, and local infection in 0.8%.

CONCLUSION: The rate of serious complications from external lumbar drainage for normal pressure hydrocephalus is low. It is hoped that continued evaluation of the procedure will lead to further reductions in the complication rate.