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Controversies in Severe Traumatic Brain Injury Management pp 29–36Cite as

Choice of Intracranial Pressure Monitoring Modality: Parenchymal Monitor vs. Parenchymal Monitor with Brain Tissue Oxygen Monitor vs. External Ventricular Drain

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Abstract

A mainstay of the modern management of severe traumatic brain injury is avoidance of secondary injury by optimizing intracranial and cerebral perfusion pressures. While many studies support the role of treatment of intracranial pressures (ICPs) above 20–22 mmHg, there is little consensus regarding the choice of external ventricular drain versus intraparenchymal monitor or the utility of multimodal monitoring, most notably brain tissue oxygen monitors. An external ventricular drain allows for drainage of cerebral spinal fluid in addition to measurement of intracranial pressures but is associated with greater difficulty in placement and higher complication rates. Intraparenchymal monitors are more easily inserted and have fewer complications but are without intrinsic therapeutic function and are associated with higher intracranial pressures and rates of surgical decompressions. The addition of a brain tissue oxygen monitor may prove to be an important reference that puts in context intracranial pressures and cerebral perfusion pressures. More recent technologies allow concomitant drainage of cerebral spinal fluid while monitoring intracranial pressures. Future technologies will incorporate ICP, brain tissue oxygenation, and brain temperature monitoring without the need for multiple device insertion.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Christian B. Ricks MD, MS & David O. Okonkwo MD, PhD

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  1. Christian B. Ricks MD, MS
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  2. David O. Okonkwo MD, PhD
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Correspondence to David O. Okonkwo MD, PhD .

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  1. Department of Neurosurgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA

    Shelly D. Timmons

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Ricks, C.B., Okonkwo, D.O. (2018). Choice of Intracranial Pressure Monitoring Modality: Parenchymal Monitor vs. Parenchymal Monitor with Brain Tissue Oxygen Monitor vs. External Ventricular Drain. In: Timmons, S. (eds) Controversies in Severe Traumatic Brain Injury Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89477-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-89477-5_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-89476-8

  • Online ISBN: 978-3-319-89477-5

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