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. 2023 Oct;108(5):340-346.
doi: 10.1136/archdischild-2022-324881. Epub 2023 Jan 20.

How to use lumbar puncture manometry in children

Jonathon Aa Holland  1   2 , Jonathan P Funnell  3 , Rhea Mittal  4 , Deepa Krishnakumar  2
Affiliations

How to use lumbar puncture manometry in children

Jonathon Aa Holland et al. Arch Dis Child Educ Pract Ed. 2023 Oct.

Abstract

Measurement of cerebrospinal fluid pressure through lumbar puncture (LP) manometry is an essential practical skill all paediatricians should possess competency in. The ability to perform manometry is crucial in the diagnosis of idiopathic intracranial hypertension and can provide critical information on raised (or lowered) intracranial pressure in other clinical scenarios. Practitioners should be familiar with the procedure and in particular with equipment available to them locally. In this article, we will describe an approach to LP manometry. The online supplemental material includes an instructional video as well as supporting practical information.

Keywords: Neurology; Paediatrics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Lumbar puncture opening pressure is a dynamic reflection of the intra-cranial pressure, which varies with both external (eg, cardiac output and cerebral venous return) and internal factors (eg, changes in volume of the brain, blood or CSF compartments), assuming free flow of CSF through to the spinal subarachnoid spaces. CSF, cerebrospinal fluid.
Figure 2
Figure 2
Three-way tap attached to a spinal manometer. The arrows on the three-way tap indicate the direction of free flow. With the "OFF" arm pointing rightwards as shown, CSF is free to flow from the LP needle (once attached via the Luer slip connector seen here on the left) up in to the manometer column.
Figure 3
Figure 3
The intercristal line (Tuffier’s line) approximates to the L4 spinous process or L4–L5 interspace. The actual level may be different, depending on patient sex and body mass index.
Figure 4
Figure 4
(A) Opening/closing pressure measurement. Three-way valve open to patient and manometer. Note the manometer is orientated perpendicular to the ground in two planes. (B) Drainage of cerebrospinal fluid from manometer. Three-way tap valve closed to patient. (C) Sample collection bypassing manometer. Three-way tap closed to manometer.
Figure 5
Figure 5
Recording of opening/closing pressure—here the meniscus would be recorded at 22.5 cm H2O.
See this image and copyright information in PMC

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