Atraumatic Lumbar Puncture

Eskey and Ogilvey (1) conclude that the use of fluoroscopically guided lumbar punctures in patients with suspected subarachnoid hemorrhage should reduce the incidence of false-positive diagnoses of acute hemorrhage and therefore the number of unnecessary angiographic procedures. The authors may wish to consider another method of obtaining a lumbar puncture based on the experience of those of us who carried out pneumoencephalography before the days of CT. With the patient sitting erect and bending forward over a pillow on his or her lap, the interspinous distances are increased. An accurate midsagittal approach is easily ascertained and access to the subarachoid space is atraumatic and simple. I would submit that this method leads to fewer false-positive results than those of the usual bedside lateral decubitus approach and is less time-consuming and costly than the biplane fluoroscopic approach, which the authors advocate.

• American Society of Neuroradiology