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Safety profile of an intracranial multimodal monitoring bolt system for neurocritical care: a single-center experience

  • Original Article - Neurosurgical intensive care
  • Published:
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Abstract

Background

Intracranial multimodality monitoring (iMMM) is increasingly used in acute brain-injured patients; however, safety and reliability remain major concerns to its routine implementation.

Methods

We performed a retrospective study including all patients undergoing iMMM at a single European center between July 2016 and January 2020. Brain tissue oxygenation probe (PbtO2), alone or in combination with a microdialysis catheter and/or an 8-contact depth EEG electrode, was inserted using a triple-lumen bolt system and targeting normal-appearing at-risk brain area on the injured side, whenever possible. Surgical complications, adverse events, and technical malfunctions, directly associated with iMMM, were collected. A blinded imaging review was performed by an independent radiologist.

Results

One hundred thirteen patients with 123 iMMM insertions were included for a median monitoring time of 9 [3–14] days. Of those, 93 (76%) patients had only PbtO2 probe insertion and 30 (24%) had also microdialysis and/or iEEG monitoring. SAH was the most frequent indication for iMMM (n = 60, 53%). At least one complication was observed in 67/123 (54%) iMMM placement, corresponding to 58/113 (51%) patients. Misplacement was observed in 16/123 (13%), resulting in a total of 6/16 (38%) malfunctioning PbtO2 catheters. Intracranial hemorrhage was observed in 14 iMMM placements (11%), of which one required surgical drainage. Five placements were complicated by pneumocephalus and 4 with bone fragments; none of these requires additional surgery. No CNS infection related to iMMM was observed. Seven (6%) probes were accidentally dislodged and 2 probes (2%) were accidentally broken. Ten PbtO2 probes (8%) presented a technical malfunction after a median of 9 [ranges: 2–24] days after initiation of monitoring and 4 of them were replaced.

Conclusions

In this study, a high occurrence of complications related to iMMM was observed, although most of them did not require specific interventions and did not result in malfunctioning monitoring.

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Availability of data and material

All the data are available on demand at mejdi.albarajraji@gmail.com.

Code availability

Not applicable.

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Funding

The research was not supported by any company. The devices were bought by the intensive care unit and the neurosurgery department to be used in daily clinical practice.

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Authors and Affiliations

  1. Department of Neurosurgery, Route de Lennik, Hopital Erasme, Université Libre de Bruxelles (ULB), 808, 1070, Brussels, Belgium

    Mejdeddine Al Barajraji, Olivier Dewitte, Salim El Hadwe, Sophie Schuind & Sami Barrit

  2. Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Elisa Bogossian, Andrea Minini & Fabio Silvio Taccone

  3. Department of Neurology, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Nicolas Gaspard

  4. Department of Radiology, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Joachim Andre

Authors
  1. Mejdeddine Al Barajraji
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  2. Elisa Bogossian
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  3. Olivier Dewitte
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  4. Nicolas Gaspard
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  8. Fabio Silvio Taccone
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  9. Sophie Schuind
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  10. Sami Barrit
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Corresponding author

Correspondence to Mejdeddine Al Barajraji.

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Ethics approval

Ethical approval was obtained from ethics committees of the Erasme Hospital, Free University of Brussels, Brussels, Belgium: file EC P2020/019.

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For this type of study, formal consent is not required.

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Consent to submit has been received from all co-authors and responsible authorities at the institute/organization where the work has been carried out before the work is submitted.

Competing interests

Fabio Silvio Taccone received lecture fees from Integra Lifescience. All other authors declare that they have no conflict of interest.

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Mejdeddine Al Barajraji and Elisa Bogossian equally contributed as first authors.

Sophie Schuind and Sami Barrit equally contributed as senior authors.

This article is part of the Topical Collection on Neurosurgical intensive care

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Al Barajraji, M., Bogossian, E., Dewitte, O. et al. Safety profile of an intracranial multimodal monitoring bolt system for neurocritical care: a single-center experience. Acta Neurochir 163, 3259–3266 (2021). https://doi.org/10.1007/s00701-021-04992-z

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  • DOI: https://doi.org/10.1007/s00701-021-04992-z

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