The increasing use of pneumoencephalography has led to a search for the safest method which will give the most uniformly satisfactory roentgenograms and the least distress to the patient. Liberson1 was the first to advocate the steady withdrawal of cerebrospinal fluid and its simultaneous replacement with gas. He used a double-chambered needle connected with a gas-filled stoppered bottle by two pieces of rubber tubing. He called attention to the rapid fluctuations in intracranial pressure produced by the method introduced by Dandy, employing a single needle and syringe, with alternate withdrawal of fluid and injection of air, and claimed that both greater safety and less discomfort resulted from the use of the simultaneous replacement method. A manometer and syringe were attached to the rubber tubing in Liberson's apparatus. Many modifications have since been described, the addition of a water-filled container through which the injected gas must bubble being the only
Holt WL, Schwab RS. AN EASILY MADE APPARATUS FOR USE IN "CLOSED SYSTEM" PNEUMOENCEPHALOGRAPHY: With Notes on Technic for Its Use. Arch NeurPsych. 1939;41(5):1021–1027. doi:10.1001/archneurpsyc.1939.02270170159010
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