Pneumocephalus Following an Uneventful Lumbar Puncture: Does the Gauge of a Spinal Needle Matter?

To the Editor: I read with interest the case report by Kozikowski and Cohen (1), which describes the occurrence of pneumocephalus following an uneventful lumbar puncture in an elderly patient. Although I agree with the authors’ list of steps (performing the lumbar puncture in the sitting position, careful monitoring of CSF drainage, avoiding air entrapment, and avoiding large, deep breaths during the procedure) that can/should be taken to prevent this complication, I believe that this list in not complete without reducing the size of the spinal needle used for drainage of CSF. This step may be particularly important in the elderly patient whose dura may be less elastic (calcified) facilitating air entrapment (what seems more likely with a larger gauge needle) and subsequent development of postlumbar puncture pneumocephalus. At this author’s institution, smaller (20- or 22-gauge) needles are routinely used for lumbar punctures. Krzysztof M.