{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T01:06:01Z","timestamp":1779843961876,"version":"3.53.1"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>C1\u20132 puncture, although infrequently performed in neurosurgical practice, remains an important alternative route for CSF access in patients in whom lumbar puncture (LP) is contraindicated or technically unfeasible. A 6-month-old patient presented with findings concerning of meningitis. LP was contraindicated due to recent lipomyelomeningocele excision and dural closure; therefore, a C1\u20132 puncture was performed instead.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A lateral C1\u20132 puncture was performed under general anesthesia and fluoroscopic guidance. Needle trajectory, depth, and safety corridor were determined using preprocedural imaging and correlated with real-time fluoroscopy. CSF was aspirated without technical difficulty or procedural complications and sent for laboratory analysis. The infant tolerated the procedure well and demonstrated no adverse events in the postoperative period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>A literature review identified no prior reports of a C1\u20132 CSF tap performed in an infant. Herein, the authors describe the successful performance of a C1\u20132 CSF tap in a 6-month-old infant for diagnostic evaluation of suspected meningitis, highlighting the technical considerations, safety measures, and clinical implications of this rarely reported approach in infancy. C1\u20132 puncture is a safe and feasible alternative for CSF sampling in infants when lumbar access is contraindicated or unsuccessful.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26185\">https:\/\/thejns.org\/doi\/10.3171\/CASE26185<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26185","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:52:37Z","timestamp":1779288757000},"source":"Crossref","is-referenced-by-count":0,"title":["C1\u20132 CSF tap in a 6-month-old infant: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2543-3617","authenticated-orcid":true,"given":"Edgar","family":"Petrosyan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2309-6510","authenticated-orcid":true,"given":"Arturo","family":"Balaguer Townsend","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaidehi","family":"Mahadev","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulasi","family":"Iyengar","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-3574","authenticated-orcid":true,"given":"Robin M.","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Raskin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago"},{"name":"Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Encephalitis","first-page":"93","article-title":"Lumbar puncture: considerations, procedure, and complications","volume":"2","author":"Kim","year":"2022","unstructured":"Kim KT.Lumbar puncture: considerations, procedure, and complications. Encephalitis. 2022;2(4):93-97. doi:10.47936\/encephalitis.2022.00045"},{"issue":"1","key":"bib2","series-title":"J Neurosurg","first-page":"106","article-title":"Lateral cervical puncture for myelography. Technical note","volume":"29","author":"Kelly","year":"1968","unstructured":"Kelly DLJrAlexander EJr.Lateral cervical puncture for myelography. Technical note. J Neurosurg. 1968;29(1):106-110. doi:10.3171\/jns.1968.29.1.0106"},{"issue":"1","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"5","article-title":"Development of the C1-C2 puncture in neuroradiology: a historical note","volume":"26","author":"Heinz","year":"2005","unstructured":"Heinz ER.Development of the C1-C2 puncture in neuroradiology: a historical note. AJNR Am J Neuroradiol. 2005;26(1):5-6."},{"issue":"3","key":"bib4","series-title":"Radiology","first-page":"629","article-title":"The role of gas myelography in neuroradiologic diagnosis. Comments on a new and simple technique","volume":"102","author":"Heinz","year":"1972","unstructured":"Heinz ERGoldman RL.The role of gas myelography in neuroradiologic diagnosis. Comments on a new and simple technique. Radiology. 1972;102(3):629-634. doi:10.1148\/102.3.629"},{"issue":"3","key":"bib5","series-title":"Radiology","first-page":"760","article-title":"Lateral C1-2 puncture for myelography: posterior approach","volume":"132","author":"Rice","year":"1979","unstructured":"Rice JFBathia AL.Lateral C1-2 puncture for myelography: posterior approach. Radiology. 1979;132(3):760-762. doi:10.1148\/132.3.760"},{"issue":"3","key":"bib6","series-title":"Radiology","first-page":"707","article-title":"Metrizamide myelography for cervical spinal cord injuries","volume":"129","author":"Leo","year":"1978","unstructured":"Leo JSBergeron RTKricheff IIBenjamin MV.Metrizamide myelography for cervical spinal cord injuries. Radiology. 1978;129(3):707-711. doi:10.1148\/129.3.707"},{"issue":"3","key":"bib7","series-title":"Neurosurgery","first-page":"ons187","article-title":"Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy","volume":"64","author":"Kanpolat","year":"2009","unstructured":"Kanpolat YUgur HCAyten MElhan AH.Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. Neurosurgery. 2009;64(3)(suppl):ons187-ons194. doi:10.1227\/01.NEU.0000335645.67282.03"},{"issue":"4","key":"bib8","series-title":"BMJ Support Palliat Care","first-page":"429","article-title":"Percutaneous cervical cordotomy for cancer-related pain: national data","volume":"10","author":"Poolman","year":"2020","unstructured":"Poolman MMakin MBriggs JPercutaneous cervical cordotomy for cancer-related pain: national data. BMJ Support Palliat Care. 2020;10(4):429-434. doi:10.1136\/bmjspcare-2019-002057"},{"issue":"4","key":"bib9","series-title":"J Neurosurg Pediatr","first-page":"389","article-title":"Placement of baclofen pump catheter through a C1-2 puncture: technical note","volume":"21","author":"Aljuboori","year":"2018","unstructured":"Aljuboori ZArcher JHuff WMoreno AJea A.Placement of baclofen pump catheter through a C1-2 puncture: technical note. J Neurosurg Pediatr. 2018;21(4):389-394. doi:10.3171\/2017.9.PEDS17289"},{"issue":"23","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE24427","article-title":"Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. 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AJNR Am J Neuroradiol. 1985;6(3):349-351."},{"issue":"1","key":"bib14","series-title":"Radiology","first-page":"79","article-title":"Cervical myelography: survey of modes of practice and major complications","volume":"174","author":"Robertson","year":"1990","unstructured":"Robertson HJSmith RD.Cervical myelography: survey of modes of practice and major complications. Radiology. 1990;174(1):79-83. doi:10.1148\/radiology.174.1.2294575"},{"issue":"3 suppl 1","key":"bib15","series-title":"Neurosurgery","first-page":"226","article-title":"Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain","volume":"62","author":"Raslan","year":"2008","unstructured":"Raslan AM.Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain. Neurosurgery. 2008;62(3 suppl 1):226-234. doi:10.1227\/01.neu.0000317397.16089.f5"},{"issue":"8","key":"bib16","series-title":"AJNR Am J Neuroradiol","first-page":"1562","article-title":"C1 posterior arch flare point: a useful landmark for fluoroscopically guided C1-2 puncture","volume":"39","author":"Peckham","year":"2018","unstructured":"Peckham MEShah LMTsai ACQuigley EPII Cramer JHutchins TA.C1 posterior arch flare point: a useful landmark for fluoroscopically guided C1-2 puncture. AJNR Am J Neuroradiol. 2018;39(8):1562-1567. doi:10.3174\/ajnr.A5706"},{"issue":"2","key":"bib17","series-title":"AJR Am J Roentgenol","first-page":"431","article-title":"The lateral C1-C2 puncture: indications, technique, and potential complications","volume":"212","author":"Daniels","year":"2019","unstructured":"Daniels SPSchweitzer ADBaidya RThe lateral C1-C2 puncture: indications, technique, and potential complications. AJR Am J Roentgenol. 2019;212(2):431-442. doi:10.2214\/AJR.18.19584"},{"issue":"1","key":"bib18","series-title":"Radiology","first-page":"172","article-title":"Normative MR cervical spinal canal dimensions","volume":"271","author":"Ulbrich","year":"2014","unstructured":"Ulbrich EJSchraner CBoesch CNormative MR cervical spinal canal dimensions. Radiology. 2014;271(1):172-182. doi:10.1148\/radiol.13120370"},{"issue":"2","key":"bib19","series-title":"Neurol India","first-page":"178","article-title":"Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study","volume":"52","author":"Cacciola","year":"2004","unstructured":"Cacciola FPhalke UGoel A.Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study. Neurol India. 2004;52(2):178-184."},{"key":"bib20","series-title":"Ann Adv Automot Med","first-page":"159","article-title":"Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography","volume":"55","author":"Yoganandan","year":"2011","unstructured":"Yoganandan NPintar FALew SMRao RDRangarajan N.Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography. Ann Adv Automot Med. 2011;55:159-168."},{"key":"bib21","series-title":"StatPearls","article-title":"Suboccipital puncture","author":"Pellot","year":"2025","unstructured":"Pellot JEDe Jesus O.Suboccipital puncture. In: StatPearls [Internet]. StatPearls Publishing; 2025. Accessed April 26, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560630\/"},{"issue":"1","key":"bib22","series-title":"J Neurosurg","first-page":"146","article-title":"A new method of subarachnoid puncture for clinical diagnosis and treatment: lateral atlanto-occipital space puncture","volume":"129","author":"Gong","year":"2018","unstructured":"Gong DYu HYuan X.A new method of subarachnoid puncture for clinical diagnosis and treatment: lateral atlanto-occipital space puncture. J Neurosurg. 2018;129(1):146-152. doi:10.3171\/2017.1.JNS161089"},{"issue":"6","key":"bib23","series-title":"Clin Infect Dis","first-page":"e34","article-title":"2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated ventriculitis and meningitis","volume":"64","author":"Tunkel","year":"2017","unstructured":"Tunkel ARHasbun RBhimraj A2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34-e65. doi:10.1093\/cid\/ciw861"},{"issue":"4","key":"bib1","series-title":"Encephalitis","first-page":"93","article-title":"Lumbar puncture: considerations, procedure, and complications","volume":"2","author":"Kim","year":"2022","unstructured":"Kim KT.Lumbar puncture: considerations, procedure, and complications. Encephalitis. 2022;2(4):93-97. doi:10.47936\/encephalitis.2022.00045"},{"issue":"1","key":"bib2","series-title":"J Neurosurg","first-page":"106","article-title":"Lateral cervical puncture for myelography. Technical note","volume":"29","author":"Kelly","year":"1968","unstructured":"Kelly DLJrAlexander EJr.Lateral cervical puncture for myelography. Technical note. J Neurosurg. 1968;29(1):106-110. doi:10.3171\/jns.1968.29.1.0106"},{"issue":"1","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"5","article-title":"Development of the C1-C2 puncture in neuroradiology: a historical note","volume":"26","author":"Heinz","year":"2005","unstructured":"Heinz ER.Development of the C1-C2 puncture in neuroradiology: a historical note. AJNR Am J Neuroradiol. 2005;26(1):5-6."},{"issue":"3","key":"bib4","series-title":"Radiology","first-page":"629","article-title":"The role of gas myelography in neuroradiologic diagnosis. Comments on a new and simple technique","volume":"102","author":"Heinz","year":"1972","unstructured":"Heinz ERGoldman RL.The role of gas myelography in neuroradiologic diagnosis. Comments on a new and simple technique. Radiology. 1972;102(3):629-634. doi:10.1148\/102.3.629"},{"issue":"3","key":"bib5","series-title":"Radiology","first-page":"760","article-title":"Lateral C1-2 puncture for myelography: posterior approach","volume":"132","author":"Rice","year":"1979","unstructured":"Rice JFBathia AL.Lateral C1-2 puncture for myelography: posterior approach. Radiology. 1979;132(3):760-762. doi:10.1148\/132.3.760"},{"issue":"3","key":"bib6","series-title":"Radiology","first-page":"707","article-title":"Metrizamide myelography for cervical spinal cord injuries","volume":"129","author":"Leo","year":"1978","unstructured":"Leo JSBergeron RTKricheff IIBenjamin MV.Metrizamide myelography for cervical spinal cord injuries. Radiology. 1978;129(3):707-711. doi:10.1148\/129.3.707"},{"issue":"3","key":"bib7","series-title":"Neurosurgery","first-page":"ons187","article-title":"Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy","volume":"64","author":"Kanpolat","year":"2009","unstructured":"Kanpolat YUgur HCAyten MElhan AH.Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. Neurosurgery. 2009;64(3)(suppl):ons187-ons194. doi:10.1227\/01.NEU.0000335645.67282.03"},{"issue":"4","key":"bib8","series-title":"BMJ Support Palliat Care","first-page":"429","article-title":"Percutaneous cervical cordotomy for cancer-related pain: national data","volume":"10","author":"Poolman","year":"2020","unstructured":"Poolman MMakin MBriggs JPercutaneous cervical cordotomy for cancer-related pain: national data. BMJ Support Palliat Care. 2020;10(4):429-434. doi:10.1136\/bmjspcare-2019-002057"},{"issue":"4","key":"bib9","series-title":"J Neurosurg Pediatr","first-page":"389","article-title":"Placement of baclofen pump catheter through a C1-2 puncture: technical note","volume":"21","author":"Aljuboori","year":"2018","unstructured":"Aljuboori ZArcher JHuff WMoreno AJea A.Placement of baclofen pump catheter through a C1-2 puncture: technical note. J Neurosurg Pediatr. 2018;21(4):389-394. doi:10.3171\/2017.9.PEDS17289"},{"issue":"23","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE24427","article-title":"Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case","volume":"8","author":"Mukherjee","year":"2024","unstructured":"Mukherjee SAbdelmageed SShahin MNRaskin JS.Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case. J Neurosurg Case Lessons. 2024;8(23):CASE24427 doi:10.3171\/CASE24427"},{"issue":"6","key":"bib11","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Safety and efficacy of continuous intrathecal baclofen via cervical catheter tip: a retrospective case series","volume":"56","author":"Mossner","year":"2024","unstructured":"Mossner JAbdelmageed SVotoupal MSafety and efficacy of continuous intrathecal baclofen via cervical catheter tip: a retrospective case series. Neurosurg Focus. 2024;56(6):E13. doi:10.3171\/2024.3.FOCUS2475"},{"issue":"7","key":"bib12","series-title":"AJNR Am J Neuroradiol","first-page":"1360","article-title":"Are C1-2 punctures for routine cervical myelography below the standard of care?","volume":"30","author":"Yousem","year":"2009","unstructured":"Yousem DMGujar SK.Are C1-2 punctures for routine cervical myelography below the standard of care? AJNR Am J Neuroradiol. 2009;30(7):1360-1363. doi:10.3174\/ajnr.A1594"},{"issue":"3","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"349","article-title":"Myelography with iohexol (Omnipaque): review of 300 cases","volume":"6","author":"Burrows","year":"1985","unstructured":"Burrows EH.Myelography with iohexol (Omnipaque): review of 300 cases. AJNR Am J Neuroradiol. 1985;6(3):349-351."},{"issue":"1","key":"bib14","series-title":"Radiology","first-page":"79","article-title":"Cervical myelography: survey of modes of practice and major complications","volume":"174","author":"Robertson","year":"1990","unstructured":"Robertson HJSmith RD.Cervical myelography: survey of modes of practice and major complications. Radiology. 1990;174(1):79-83. doi:10.1148\/radiology.174.1.2294575"},{"issue":"3 suppl 1","key":"bib15","series-title":"Neurosurgery","first-page":"226","article-title":"Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain","volume":"62","author":"Raslan","year":"2008","unstructured":"Raslan AM.Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain. Neurosurgery. 2008;62(3 suppl 1):226-234. doi:10.1227\/01.neu.0000317397.16089.f5"},{"issue":"8","key":"bib16","series-title":"AJNR Am J Neuroradiol","first-page":"1562","article-title":"C1 posterior arch flare point: a useful landmark for fluoroscopically guided C1-2 puncture","volume":"39","author":"Peckham","year":"2018","unstructured":"Peckham MEShah LMTsai ACQuigley EPII Cramer JHutchins TA.C1 posterior arch flare point: a useful landmark for fluoroscopically guided C1-2 puncture. AJNR Am J Neuroradiol. 2018;39(8):1562-1567. doi:10.3174\/ajnr.A5706"},{"issue":"2","key":"bib17","series-title":"AJR Am J Roentgenol","first-page":"431","article-title":"The lateral C1-C2 puncture: indications, technique, and potential complications","volume":"212","author":"Daniels","year":"2019","unstructured":"Daniels SPSchweitzer ADBaidya RThe lateral C1-C2 puncture: indications, technique, and potential complications. AJR Am J Roentgenol. 2019;212(2):431-442. doi:10.2214\/AJR.18.19584"},{"issue":"1","key":"bib18","series-title":"Radiology","first-page":"172","article-title":"Normative MR cervical spinal canal dimensions","volume":"271","author":"Ulbrich","year":"2014","unstructured":"Ulbrich EJSchraner CBoesch CNormative MR cervical spinal canal dimensions. Radiology. 2014;271(1):172-182. doi:10.1148\/radiol.13120370"},{"issue":"2","key":"bib19","series-title":"Neurol India","first-page":"178","article-title":"Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study","volume":"52","author":"Cacciola","year":"2004","unstructured":"Cacciola FPhalke UGoel A.Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study. Neurol India. 2004;52(2):178-184."},{"key":"bib20","series-title":"Ann Adv Automot Med","first-page":"159","article-title":"Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography","volume":"55","author":"Yoganandan","year":"2011","unstructured":"Yoganandan NPintar FALew SMRao RDRangarajan N.Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography. Ann Adv Automot Med. 2011;55:159-168."},{"key":"bib21","series-title":"StatPearls","article-title":"Suboccipital puncture","author":"Pellot","year":"2025","unstructured":"Pellot JEDe Jesus O.Suboccipital puncture. In: StatPearls [Internet]. StatPearls Publishing; 2025. Accessed April 26, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560630\/"},{"issue":"1","key":"bib22","series-title":"J Neurosurg","first-page":"146","article-title":"A new method of subarachnoid puncture for clinical diagnosis and treatment: lateral atlanto-occipital space puncture","volume":"129","author":"Gong","year":"2018","unstructured":"Gong DYu HYuan X.A new method of subarachnoid puncture for clinical diagnosis and treatment: lateral atlanto-occipital space puncture. 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