• Tarik F Massoud and Bryan A Lanzman.
• Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Stanford University School of Medicine, Stanford Health Care, Stanford, USA; Department of Radiology, Stanford University Center for Academic Medicine, Radiology, MC: 5659, 453 Quarry Road, Palo Alto, CA 94304, USA. Electronic address: tmassoud@stanford.edu.
• Neuroimaging Clin. N. Am. 2025 Feb 1; 35 (1): 415241-52.

AbstractPatients requiring lumbar punctures (LPs) are frequently challenging or may be impossible to do through a standard lower lumbar route. Therefore, if clinically indicated, consideration of alternative anatomic access routes to the spinal subarachnoid space may be necessary. However, some of these approaches are unpopular or seldom used, may be challenging to perform, or are associated with potential significant complications especially when combined with limited operator experience. Here we review the techniques and drawbacks of multiple different approaches for percutaneous insertion of spinal needles into the spinal dural sac as alternatives to standard interlaminar low LPs.Copyright © 2024 Elsevier Inc. All rights reserved.

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