• Arthie Jeyakumar, John J Weaver, ChickJeffrey Forris BeechamJFBDivision of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way Northea, Anthony N Hage, Kevin S H Koo, Giridhar M Shivaram, and Eric J Monroe.
• Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
• Pediatr Radiol. 2021 Feb 1; 51 (2): 289-295.

BackgroundThe safety and efficacy of US-guided lumbar puncture in children has been described. In the pediatric setting, children are frequently referred to interventional radiology only after a failed landmark-based attempt. Routine pre-procedure US in these children is useful to determine a safe level for subarachnoid access and to optimize success.ObjectiveTo determine whether pre-procedure US improves technical success and safety of US-guided lumbar puncture.Materials And MethodsWe included 47 children. Inclusion criteria were urgent US-guided lumbar puncture in pediatric patients <18 years old. Exclusion criteria were non-urgent lumbar punctures, children referred without an antecedent landmark-based attempt, lumbar punctures performed with fluoroscopic guidance, and procedures performed prior to introducing the diagnostic approach in 2017. We did not evaluate data pertaining to successful landmark-based lumbar punctures performed without subsequent need for additional attempts. We recorded technical successes, adverse events and relevant abnormalities identified on pre-procedural US.ResultsThirty-six US-guided lumbar punctures were performed with 100% technical success. Eleven children referred to interventional radiology did not undergo lumbar puncture because of unfavorable US findings or interval clinical improvement obviating the need for lumbar puncture. Thirty-six children underwent US evaluation of the thecal sac prior to potential intervention. Of these 36 with pre-procedural US studies, 12 demonstrated paucity of cerebrospinal fluid and 14 demonstrated an epidural hematoma. Fifteen children who underwent lumbar puncture had a "traumatic tap," classified as a mild adverse event. No moderate or severe adverse events were recorded.ConclusionLimited spinal US following failed landmark-based lumbar punctures frequently identifies procedure-related complications and can augment patient selection for future image-guided lumbar punctures.

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