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Intracranial Monitors in Neurosurgical Critical Care

  • Matthew A. Kirkman
Chapter

Abstract

The critical care management of patients with any form of brain injury is critically dependent on the monitoring of systemic and central nervous system physiology. A range of invasive and noninvasive, global and regional monitors of cerebral hemodynamics, oxygenation, metabolism, and electrophysiology are available at the clinician’s disposal to do this. This chapter discusses the epidemiology, prevention, detection, and management of the most frequently encountered complications associated with the use of four commonly used devices: external ventricular drains (EVDs), intraparenchymal intracranial pressure (ICP) monitors, brain tissue oxygen (PbtO2) monitors, and cerebral microdialysis (CMD) probes.

Keywords

Brain tissue oxygen Cerebral microdialysis External ventricular drain Infection Intracranial pressure monitoring Hemorrhage Technical complications Ventricular catheter 

Suggested Reading

Intracranial Pressure Monitoring

  1. Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6–15.  https://doi.org/10.1227/NEU.0000000000001432.CrossRefPubMedGoogle Scholar

Brain Tissue Oxygen Monitoring

  1. Nangunoori R, Maloney-Wilensky E, Stiefel M, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review. Neurocrit Care. 2012;17:131–8.  https://doi.org/10.1007/s12028-011-9621-9.CrossRefPubMedGoogle Scholar

Cerebral Microdialysis

  1. Bossers SM, de Boer RD, Boer C, Peerdeman SM. The diagnostic accuracy of brain microdialysis during surgery: a qualitative systematic review. Acta Neurochir. 2013;155:345–53.  https://doi.org/10.1007/s00701-012-1582-z.CrossRefPubMedGoogle Scholar
  2. Hutchinson PJ, Jalloh I, Helmy A, et al. Consensus statement from the 2014 International Microdialysis Forum. Intensive Care Med. 2015;41:1517–28.  https://doi.org/10.1007/s00134-015-3930-y.CrossRefPubMedPubMedCentralGoogle Scholar

Infection

  1. Chen JW, Rogers SL, Gombart ZJ, Adler DE, Cecil S. Implementation of cerebral microdialysis at a community-based hospital: a 5-year retrospective analysis. Surg Neurol Int. 2012a;3:57.  https://doi.org/10.4103/2152-7806.96868.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Dey M, Stadnik A, Riad F, et al. Bleeding and infection with external ventricular drainage: a systematic review in comparison with adjudicated adverse events in the ongoing Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-III IHV) trial. Neurosurgery. 2015a;76:291–300– discussion 301.  https://doi.org/10.1227/NEU.0000000000000624.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Fried HI, Nathan BR, Rowe AS, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement : a statement for healthcare professionals from the neurocritical care society. Neurocrit Care. 2016;24:61–81.  https://doi.org/10.1007/s12028-015-0224-8.CrossRefPubMedGoogle Scholar
  4. Gelabert-González M, Ginesta-Galan V, Sernamito-García R, et al. The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases. Acta Neurochir. 2006a;148:435–41.  https://doi.org/10.1007/s00701-005-0683-3.CrossRefPubMedGoogle Scholar
  5. Konstantelias AA, Vardakas KZ, Polyzos KA, et al. Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis. J Neurosurg. 2015;122:1096–112.  https://doi.org/10.3171/2014.12.JNS14908.CrossRefPubMedGoogle Scholar
  6. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ESJ. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51:170–81. discussion 181–2CrossRefGoogle Scholar
  7. Stuart RM, Schmidt M, Kurtz P, et al. Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices. Neurocrit Care. 2010a;12:188–98.  https://doi.org/10.1007/s12028-010-9330-9.CrossRefPubMedGoogle Scholar

Hemorrhage

  1. Binz DD, Toussaint LG, Friedman JA. Hemorrhagic complications of ventriculostomy placement: a meta-analysis. Neurocrit Care. 2009;10:253–6.  https://doi.org/10.1007/s12028-009-9193-0.CrossRefPubMedGoogle Scholar
  2. Chen JW, Rogers SL, Gombart ZJ, Adler DE, Cecil S. Implementation of cerebral microdialysis at a community-based hospital: a 5-year retrospective analysis. Surg Neurol Int. 2012b;3:57.  https://doi.org/10.4103/2152-7806.96868.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Dey M, Stadnik A, Riad F, et al. Bleeding and infection with external ventricular drainage: a systematic review in comparison with adjudicated adverse events in the ongoing Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage Phase III (CLEAR-III IHV) trial. Neurosurgery. 2015b;76:291–300– discussion 301.  https://doi.org/10.1227/NEU.0000000000000624.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Fried HI, Nathan BR, Rowe AS, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement : a statement for healthcare professionals from the neurocritical care society. Neurocrit Care. 2016;24:61–81.  https://doi.org/10.1007/s12028-015-0224-8.CrossRefPubMedGoogle Scholar
  5. Gelabert-González M, Ginesta-Galan V, Sernamito-García R, et al. The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases. Acta Neurochir. 2006b;148:435–41.  https://doi.org/10.1007/s00701-005-0683-3.CrossRefPubMedGoogle Scholar
  6. Stuart RM, Schmidt M, Kurtz P, et al. Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices. Neurocrit Care. 2010b;12:188–98.  https://doi.org/10.1007/s12028-010-9330-9.CrossRefPubMedGoogle Scholar

Malpositioning/Malfunctioning

  1. Chen JW, Rogers SL, Gombart ZJ, Adler DE, Cecil S. Implementation of cerebral microdialysis at a community-based hospital: a 5-year retrospective analysis. Surg Neurol Int. 2012c;3:57.  https://doi.org/10.4103/2152-7806.96868.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Fried HI, Nathan BR, Rowe AS, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the neurocritical care society. Neurocrit Care. 2016;24:61–81.  https://doi.org/10.1007/s12028-015-0224-8.CrossRefPubMedGoogle Scholar
  3. Gelabert-González M, Ginesta-Galan V, Sernamito-García R, et al. The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases. Acta Neurochir. 2006c;148:435–41.  https://doi.org/10.1007/s00701-005-0683-3.CrossRefPubMedGoogle Scholar
  4. Stuart RM, Schmidt M, Kurtz P, et al. Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices. Neurocrit Care. 2010c;12:188–98.  https://doi.org/10.1007/s12028-010-9330-9.CrossRefPubMedGoogle Scholar
  5. Toma AK, Camp S, Watkins LD, et al. External ventricular drain insertion accuracy: is there a need for change in practice? Neurosurgery. 2009;65:1197–200– discussion 1200–1.  https://doi.org/10.1227/01.NEU.0000356973.39913.0B.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Matthew A. Kirkman
    • 1
  1. 1.Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and NeurosurgeryUniversity College London HospitalsLondonUK

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