BRAIN CATHETERIZATION FOR MONITORING INTRACRANIAL PRESSURE, TISSUE OXYGEN AND BIOCHEMISTRY. SERIES OF54 PATIENTS.

P.G. Papanikolaou, A.Markellos, K.Barkas, E.K. Papadopoulos, S.Stamatiou, T. S. Paleologos, A.Venetikidis, L.Voidonikolas,E.Manousakis, G.Tsanis, E.Chatzidakis, K.Kazdaglis

Neurosurgical Department,General Hospital of Nikea - Piraeus, Athens, Greece

What’s the point in monitoring ?

Avoid secondary events causing ischemia

Early diagnosis of “late” hematomas

Early diagnosis of vasospasm in SAH

We need monitoring techniques :

easily, quickly and safely applied

easily interpreted

established alarm limits guiding treatment algorithms

Intraparenchymal brain catheters (ICP, PbtiO2, Microdialysis, rCBF-TD)

-Easy

-Low infection rate

-Transportable

-Multimodal (ICP,CPP, CBF, Oxygenation &Metabolism)

- “Invasive”

- “Local”

- Zero drift ~7-10 days

“Invasive” “Local”

Very low complication rate and short learning curve for placement in almost all studies

- Harris CH et al. Placement of intracranial pressure monitors by non-neurosurgeons. Am Surg. 2002 Sep;68(9):787-90.

- Ko K et al Training protocol for intracranial pressure monitor placement by nonneurosurgeons: 5-year experience. J Trauma. 2003 Sep;55(3):480-3; discussion 483-4.

- Dings J et al. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes.Neurosurgery. 1998 Nov;43(5):1082-95.

“Normal” frontal lobe white matter reflects global oxygenation and metabolism

- Gupta AK et al Measurement of brain tissueoxygenation performed using positron emissiontomography scanning to validate a novel monitoringmethod. J Neurosurg. 2002 Feb;96(2):263-8.

Local may be advantageous in monitoring vulnerable tissue

- Sarrafzadeh AS, Sakowitz OW, Kiening KL, BenndorfG, Lanksch WR, Unterberg AW. Bedsidemicrodialysis: a tool to monitor cerebral metabolismin subarachnoid hemorrhage patients? Crit CareMed.2002 May;30(5):1062-70

Οur experience

Multimodal neuromonitoring in 54 TBI or SCH patients using intraparenchymal brain catheters

Twist hand drill burr hole

Single same burr hole 5.3 mm

3 – lumen cranial bolt (LICOX)

ICP, PtiO2, microdialysis

Procedure bedside in ICU board

Catheter’s

tip

Our experience from 54 cases

49 three lumen cranial bolt and 5 three lumen + Hemedex

No clinically significant infection in all cases 2 cases (3,7%): colonization with Staph. epidermidis

without clinical significance

Contusion from insertion in 2 cases (3,7%) < 2 cm on CT, without neurological impact

Material failure (5,5%) 1 ICP

2 Microdialysis

Contusion from catheter insertion

Catheters’ tips placement

DAI patients

Non-dominant frontal lobe

Contusions

Penubra of the largest lesion

Treatment strategies

CPP targeted therapy

- CPP > 60 mm Hg

- ICP < 20 mm Hg

- PtiO2 > 20 mm Hg

- L / P ≤ 25

ICP and PtiO2 data determined the treatment.

Microdialysis biochemistrydefined important clinical decisions concerning the management of certain cases.

Conclusion

Multimodal neuromonitoring using intraparenchymal brain catheters seems to be safe, reliable and clinically useful.

Catheterization procedure can be safely done on ICU bed.

Neuromonitoring data seems to correlate to outcome.