Feasibility of lumbar puncture in the presence of cerebral mass effect (P2.183)

Objective: The contraindications for lumbar puncture (LP) in the setting of cerebral mass effect remain debatable. Case reports advocate its potential feasibility and safety. Yet, guidelines specifically addressing this topic are not available. Background: We reviewed 1072 consecutive patients who underwent LP and cerebral imaging a week before or after LP from 2007–2014. All individuals with evidence of brain herniation, or a component of midline shift, or mass effect were included. All subjects received a low volume LP (5–10 cc of CSF). Design/Methods: Case series Results: There were 132 patients with radiological evidence of increased intracranial pressure. Midline shift (average midline shift of 4 mm) was present in 39 patients. We also observed uncal herniation (n=16), subfalcine herniation (n=15), and a combination of both (n=10). Partial ventricular effacement: unilateral lateral ventricle (n=17), bilateral lateral ventricle (n=4), 3rd ventricle (n=11), 3rd ventricle plus unilateral ventricles (n=8), bilateral lateral ventricles plus 3rd ventricle (n=1). Besides, there were 23 patients with 4th ventricle partial effacement, 3 patients with 3rd and 4th partial ventricular involvement. Cisternal compression with partial occlusion: Quadrigeminal cistern (n=3), cerebellar-pontine-angle cistern (n= 14), ambient cistern (n=24), crural cistern (n=14), prepontine cistern (n=7), suprasellar cistern (n=12), basal cistern (n= 2), suprachiasmatic cistern (n= 4), cisterna magna (n=3), interpeduncular cistern (n=3 p), medullary cistern (n=4). All subjects tolerated the LP without complications. However, four passed away within a week because their families decided to withdraw care. Conclusions: As far as brain compliance cannot yet be determined radiologically, we believe anatomical involvement should drive decision-making regarding LP safety. Our data suggest that a low volume LP (5–10 cc) might be safe in individuals with subfalcine herniation, midline mass effect Disclosure: Dr. Kandregula has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Pace has nothing to disclose. Dr. Bozorgi has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Manjila has nothing to disclose. Dr. Gokhale has nothing to disclose. Dr. Dorn has nothing to disclose. Dr. Ramos-Estebanez has nothing to disclose.