Normal saline injection via lumbar puncture for the treatment of acute tonsillar herniation: a report of 45 cases.

Abstract

Current treatment of apnea attributable to acute tonsillar herniation often is inadequate. This study was undertaken to verify the clinical usefulness of normal saline injection via lumbar puncture for the treatment of apnea secondary to acute tonsillar herniation. Between 1969 and 2009, 45 patients who had not regained spontaneous respiratory function after external ventricular drainage or removal of a supratentorial lesion via open craniotomy received an injection of normal saline via lumbar puncture. Patient data were retrospectively analyzed. Eleven of the 45 patients regained spontaneous breathing and recovered fully (24.4%). Sixteen patients regained spontaneous breathing but died later (35.6%), and 18 patients did not regain spontaneous respiration (40.0%). The overall rate of effectiveness of injected normal saline was therefore 60.0%. For patients with tonsillar hernia who did not regain spontaneous respiration after external ventricular drainage or removal of a supratentorial lesion, an aggressive approach may be considered. Injection of normal saline via lumbar puncture could improve outcome in some of these patients.