Durapunktion

Durapunktion, or dural puncture, is a medical procedure in which the dura mater, the outer meningeal layer surrounding the brain and spinal cord, is punctured to access the cerebrospinal fluid (CSF) in the subarachnoid space. The term is commonly encountered in the context of lumbar puncture (spinal tap), where CSF is collected for analysis or where medications can be injected intrathecally.

Indications for durapunction include diagnostic purposes such as evaluating meningitis, inflammatory or neoplastic disease, and measuring CSF opening pressure. It is also used therapeutically to relieve intracranial or spinal pressure by draining CSF, to administer intrathecal therapies such as antibiotics, chemotherapy, or analgesics, and to facilitate certain anesthesia techniques like spinal anesthesia.

The procedure is typically performed under sterile conditions with the patient in a seated or lateral decubitus position. A local anesthetic is usually given, and a needle is advanced through tissues to pierce the dura mater and access the CSF. Though generally safe, durapunction carries risks, including post-dural puncture headache due to CSF leakage, infection, bleeding, and, in rare cases, nerve injury or herniation if there is an undiagnosed mass effect or elevated intracranial pressure.

Contraindications include patient refusal, infection at the puncture site, certain coagulation abnormalities, and increased intracranial pressure without appropriate imaging. The choice of performing a durapunction depends on clinical need, with alternatives or complementary approaches guided by the underlying condition and patient factors.