Ultrasound-guided atlanto-occipital puncture for cerebrospinal fluid analysis on the standing horse.
Authors: Depecker M, Bizon-Mercier C, Couroucé-Malblanc A
Journal: The Veterinary record
Summary
# Ultrasound-guided cerebrospinal fluid collection in standing horses Cerebrospinal fluid analysis is essential for diagnosing equine neurological disease, yet traditional collection methods at the atlanto-occipital site require general anaesthesia—a significant limitation for horses with severe neurological signs or when cost is prohibitive. Depecker and colleagues investigated whether ultrasound guidance could enable safe CSF retrieval in standing, sedated horses using a parasagittal technique with a 20-gauge spinal needle. All seven horses (six healthy and one mildly ataxic) yielded adequate CSF volumes (20 ml) without blood contamination or adverse reactions during dura penetration, following sedation with acepromazine and detomidine. Whilst these preliminary results are encouraging, the sample size was small and limited to horses with minimal neurological compromise, so further investigation in larger populations of ataxic animals is needed before adopting this as routine clinical practice. For practitioners, the technique demonstrates promise as a practical alternative when general anaesthesia poses unacceptable risks or financial barriers, though current evidence suggests it should remain within specialist centres with appropriate ultrasound expertise and close monitoring protocols.
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Practical Takeaways
- •Atlanto-occipital CSF collection can be performed on standing horses using ultrasound guidance and sedation alone, avoiding the need for general anaesthesia in horses with severe neurological signs or where anaesthesia is contraindicated
- •Proper safety measures and close observation remain essential, as this is a novel application with limited evidence in ataxic horses
- •Further research on larger numbers of ataxic horses is needed before recommending this as standard alternative to anaesthetised collection
Key Findings
- •Ultrasound-guided atlanto-occipital CSF puncture was successfully performed on all 7 standing horses (6 healthy, 1 mildly ataxic) with adequate sedation
- •All horses yielded 20 ml of CSF with no blood contamination and no adverse reactions when crossing the dura mater
- •The technique used parasagittal ultrasonic guidance with a 20 g, 3.5 inch spinal needle and is feasible without general anaesthesia