ABSTRACT
BACKGROUND: Intracranial pressure (ICP) monitoring has become standard in the management of neurocritical patients. A variety of monitoring techniques and devices are available, each offering advantages and disadvantages. Analysis of large populations has never been performed. PATIENTS AND METHODS: A prospective study was designed to evaluate the Camino fiberoptic intraparenchymal cerebral pressure monitor for complications and accuracy. RESULTS: Between 1992-2004 one thousand consecutive patients had a fiberoptic ICP monitor placed. The most frequent indication for monitoring was severe head injury (697 cases). The average duration of ICP monitoring was 184.6 +/- 94.3 hours; the range was 16-581 hours. Zero drift (range, -17 to 21 mm Hg; mean 7.3 +/- 5.1) was recorded after the devices were removed from 624 patients. Mechanical complications such as: breakage of the optical fiber (n = 17); dislocations of the fixation screw (n = 15) or the probe (n = 13); and failure of ICP recording for unknown reasons (n = 4) were found in 49 Camino devices. CONCLUSIONS: The Camino ICP sensor remains one of the most popular ICP monitoring devices for use in critical neurosurgical patients. The system offers reliable ICP measurements in an acceptable percentage of device complications and the advantage of in vivo recalibration. The incidence of technical complications was low and similar to others devices.
Subject(s)
Fiber Optic Technology/instrumentation , Intracranial Hypertension/diagnosis , Intracranial Pressure/physiology , Manometry/instrumentation , Monitoring, Physiologic/instrumentation , Transducers, Pressure/trends , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Brain Diseases/complications , Brain Diseases/physiopathology , Child , Child, Preschool , Female , Fiber Optic Technology/methods , Fiber Optic Technology/trends , Humans , Infant , Intracranial Hypertension/etiology , Intracranial Hypertension/prevention & control , Male , Manometry/adverse effects , Manometry/methods , Middle Aged , Monitoring, Physiologic/adverse effects , Monitoring, Physiologic/methods , Neurosurgical Procedures/instrumentation , Neurosurgical Procedures/methods , Neurosurgical Procedures/trends , Optical Fibers , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Prospective Studies , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Transducers, Pressure/adverse effectsABSTRACT
BACKGROUND: Regional cerebral blood flow may be compromised during aneurysm surgery. This may occur during vessel occlusion by temporary cliping or result from the malposition of an aneurysm clip. In this report we monitored intra-operatively the brain tissue oxygen concentration (PtiO2) to visualize regional ischaemic events. METHOD: During surgery of 10 intracranial aneurysms, monitoring of PtiO2 was performed using a polarographic microcatheter (Licox, GMS-Kiel-Germany), which was placed in the vascular territory of the artery harboring the aneurysm. FINDINGS: No complications were observed after implantation of Licox electrodes. In 6 patients PtiO2 decreased during transient clipping. In two patients PtiO2 decreased below 2 mmHg without morphological or clinical signs cerebral ischemia. In four patients, without incidence during surgery, only minor oscillations were observed. CONCLUSION: Intra-operative monitoring of PtiO2 is a complimentary procedure to monitor cerebral perfusion and detect episodes of ischaemia. Given the rapid detection of these events, therapeutic intervention may be initiated before irreversible neuronal damage occurs.
Subject(s)
Aneurysm, Ruptured/surgery , Brain Ischemia/diagnosis , Brain/surgery , Intracranial Aneurysm/surgery , Intraoperative Complications/diagnosis , Monitoring, Intraoperative , Oxygen Consumption/physiology , Subarachnoid Hemorrhage/surgery , Adult , Aneurysm, Ruptured/physiopathology , Brain/physiopathology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/surgery , Brain Ischemia/physiopathology , Carotid Artery, Internal/surgery , Craniotomy , Female , Humans , Intracranial Aneurysm/physiopathology , Intraoperative Complications/physiopathology , Male , Middle Aged , Prognosis , Subarachnoid Hemorrhage/physiopathology , Surgical InstrumentsABSTRACT
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