Encephalocentesis: Surgical Brain Puncture – Indications and Technique

Encephalocentesis (cerebral puncture) is needle/trocar penetration of the skull into brain parenchyma.

Indications

• CSF sampling when lumbar puncture contraindicated (e.g., mass lesion, elevated ICP).
• Intracranial pressure (ICP) monitoring (bolt/catheter).
• Intracerebral hemorrhage/abscess aspiration.
• Intratumoral chemotherapy or gene therapy delivery.
• Stereotactic biopsy.

Technique

1. Stereotactic frame or neuronavigation for trajectory planning.
2. Burr hole; dura opened.
3. Needle advanced to target; sample obtained or catheter placed.
4. Hemostasis; closure.

Risks

Hemorrhage, infection, seizures, neurological deficit, pneumocephalus. Performed by neurosurgeons in OR/ICU setting.