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Dura-arachnoid lesions produced by 22 gauge Quincke spinal needles during a lumbar puncture

¹ Department of Anaesthesiology and Critical Care, Hospital de Móstoles, Madrid, Spain
² Department of Anaesthesiology, Hospital Madrid Montepríncipe, Madrid, Spain
³ Department of Anaesthesiology, Critical Care and Pain Therapy, Hospital General Universitario, Valencia, Spain
⁴ Department of Anaesthesiology and Critical Care, Hospital Ramón y Cajal, Madrid, Spain

Correspondence to:
Correspondence to:
Dr M A Reina
Valmojado 95 1°B, 28047 Madrid, Spain; miguelangel.rei{at}terra.es

Aims: The dural and arachnoid hole caused by lumbar puncture needles is a determining factor in triggering headaches. The aim of this study is to assess the dimensions and morphological features of the dura mater and arachnoids when they are punctured by a 22 gauge Quincke needle having its bevel either in the parallel or in the transverse position.

Methods: Fifty punctures were made with 22 gauge Quincke needles in the dural sac of four fresh cadavers using an "in vitro" model especially designed for this purpose. The punctures were performed by needles with bevels parallel or perpendicular to the spinal axis and studied under scanning electron microscopy.

Results: Thirty five of the 50 punctures done by Quincke needles (19 in the external surface and 16 in the internal) were used for evaluation. When the needle was inserted with its bevel parallel to the axis of the dural sac (17 of 35), the size of the dura-arachnoid lesion was 0.032 mm² in the epidural surface and 0.037 mm² in the subarachnoid surface of the dural sac. When the needle’s bevel was perpendicular to the axis (18 of 35) the measurement of the lesion size was 0.042 mm² for the external surface and 0.033 mm² for the internal. There were no statistical significant differences between these results.

Conclusions: It is believed that the reported lower frequency of postdural puncture headache when the needle is inserted parallel to the cord axis should be explained by some other factors besides the size of the dura-arachnoid injury.

Keywords: meninges; dura mater; arachnoids; spinal anaesthesia; postdural puncture headache; needles; dural lesion; microscopy; scanning electron microscopy

Abbreviations: PDPH, postdural puncture headache; CSF, cerebrospinal fluid; DAL, dura-arachnoid lesion; SEM, scanning electron microscopy

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