Introduction: Two types of spinal catheters currently exist: Lumbar drains to remove cerebrospinal fluid (CSF) and intrathecal catheters to deliver drugs to the subarachnoid space (SAS). Both catheters are composed of a single lumen. This study reports on a novel dual-lumen catheter and lumbar delivery technique to remove and reintroduce cerebrospinal CSF into the SAS.
Methods: An ovine model (n=12) was utilized with a modified Seldinger approach to place a custom, coaxial dual-lumen catheter in the SAS. The catheter was inserted over a guidewire (OTW), directly above the ovine spinal cord. The catheter aspiration holes were positioned around T13-L2 with distal return holes at T1-T3. Using an extracorporeal system, CSF was withdrawn, passed through a peristaltic pump, and returned at flow rates ranging from 0.5 ml/min to 2.0 ml/min for up to 24 hours of pump time. The animals were survived between 2 days and 8-weeks post-implant, and histology was performed on spinal cord at the insertion site, location of the aspiration and return holes, and at a control section in the mid-thoracic region.
Results: Lameness assessments indicated that placement of a dual-lumen catheter and removal and reintroduction of CSF in the SAS was safe. Histological analyses also demonstrated no functional tissue damage. Acute signs of minor trauma associated with lumbar puncture resolved in 1-2 weeks. There was no indication of adhesive arachnoiditis. Additionally, there were no signs of infection or sickness in any animal at any time.
Conclusions: OTW placement of a novel dual-lumen catheter resulted in no significant tissue damage upon histological analysis. Further, aspirating and returning CSF at flow rates up to 2.0 ml/min caused no additional injury. The data suggests that the catheter and flow rates used may be a safe and effective tool to monitor and condition CSF in a large animal model.
Patient Care: By the conclusion of this session, participants should aware of an emerging technology for managing CSF.
Learning Objectives: By the conclusion of this session, participants should be aware of a novel spinal catheter.