C1–2 CSF tap in a 6-month-old infant: illustrative case

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BACKGROUND: C1-2 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 C1-2 puncture was performed instead. OBSERVATIONS: A lateral C1-2 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. LESSONS: A literature review identified no prior reports of a C1-2 CSF tap performed in an infant. Herein, the authors describe the successful performance of a C1-2 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. C1-2 puncture is a safe and feasible alternative for CSF sampling in infants when lumbar access is contraindicated or unsuccessful. https://thejns.org/doi/10.3171/CASE26185.

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