![]() ![]() ![]() CSF draining through the foramen of Luschka flows into the cisterna magna, then upwards into the subarachnoid space overlying the cerebral cortex. Egress of CSF through the foramen of Magendie results in the filling of the spinal subarachnoid space, from where CSF is drained by lumbar puncture. CSF from the fourth ventricle flows laterally through the foramen of Luschka and the foramen of Magendie, medially to the subarachnoid space. The CSF secreted in the lateral ventricles passes first into the third ventricle, then downwards through the aqueduct of Sylvius into the fourth ventricle. The red arrows in Figure 1 show the main channels of CSF flow. 2 The ependymal surfaces of the ventricles and arachnoid membranes also produce small amounts. Most CSF is formed by the choroid plexus of the ventricles at a rate of approximately 0.35 cm 3/min, or 500 cm 3/day, which is three to four times the total volume of CSF. Search terms included combinations of the Medical Subject Headings “spinal puncture”, “meningitis”, “cerebrospinal fluid”, “injections, spinal”, “central nervous system”, “practice guideline”, “prevention and control”, “post-dural post-lumbar puncture headache”, “trends”, “check list”, “outpatient”, “complication”, “meningeal enhancement post-LP”, “CT prior to LP”, “difficult LP” and “biomarkers/cerebrospinal fluid”. The references cited in the reviews were also analysed. We also reviewed published consensus guidelines and expert opinions. With the keywords “lumbar puncture”, “spinal tap” and “CSF examination”, we searched in Google Scholar, Embase, PubMed, Medline and the Cochrane Library for relevant articles, case reports, case series, meta-analyses and systematic reviews.
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