Interpretation of lumbar puncture opening pressure measurements in children.

BACKGROUND: Understanding the reference range of cerebrospinal fluid opening pressure (CSFOP) in children is essential to the diagnosis of elevated intracranial pressure. Recent studies have highlighted several clinical elements that need to be considered when interpreting CSFOP measures.

EVIDENCE ACQUISITION: This review and recommendations are based on peer-reviewed literature, primarily from the past decade, as well as the author's clinical and research experience.

RESULTS: CSFOP measures ≤28 cm H2O can be considered "normal" for most children. The patient's depth of sedation, body mass index, and sedation medication can sometimes result in small increases in CSFOP. Patient age and leg position (flexed vs extended) in the lateral decubitus position do not seem to significantly impact CSFOP measures.

CONCLUSIONS: The threshold of a normal CSFOP should not be interpreted in isolation, but instead, in concert with other clinical and examination findings to help the physician make a well-informed assessment of whether a child has elevated intracranial pressure.