Gestation-Related Reduction in Lumbar Cerebrospinal Fluid Volume and Dural Sac Surface Area

Abstract

These findings indicate an association between gestational week (Weeks 31-39) and a reduction in both CSF volume and dural sac surface area. These reductions may, at least in part, explain the facilitation of the spread of intrathecal anesthesia in pregnant women.

Tethered Cord as a Complication of Chronic Cerebral Spinal Fluid Diversion

“…Onuki et al have suggested that during the third trimester of gestation a decrease in lumbosacral CSF volume may be observed. 6 Silverberg et al have reported a decreased production rate in dementia of the Alzheimer's type. 7 Dry lumbar punctures have also been reported in cases with an epidural abscess.…”

Comparison of relative potency of intrathecal bupivacaine for motor block in pregnant versus non-pregnant women

“…17 Recently, magnetic resonance imaging (MRI) has shown a significantly reduced mean CSF volume and dural sac surface area in pregnant subjects. 18 Non-mechanical factors, such as an increase in progesterone concentration during pregnancy, may alter the susceptibility of nerves to local anesthetics during pregnancy. 19 Mechanisms which may be involved include direct effects on membrane excitability, indirect actions on neurotransmitters, increased permeability of the neural sheath and potentiation of the analgesic effect of endogenous opioids.…”

Anesthetic management of labor and delivery in patients with elevated intracranial pressure

“…5 Epidural blood vessels become engorged during the third trimester of pregnancy, resulting in a reduction in both CSF volume and dural sac surface area. 6 This may explain the increased sensory level achieved by neuraxial anesthesia in pregnancy. 6 Focal etiologies of increased intracranial pressure…”

“…6 This may explain the increased sensory level achieved by neuraxial anesthesia in pregnancy. 6 Focal etiologies of increased intracranial pressure…”