Brain monitoring using intraparenchymal cathters

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World Neurosurgical Congress (WFNS), Boston, 2009

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Brain monitoring using intraparenchymal cathters

  1. 1. P.G. Papanikolaou, A.Markellos, K.Barkas, E.K. Papadopoulos, S.Stamatiou, T. S. Paleologos, A.Venetikidis, L.Voidonikolas,<br />E.Manousakis, G.Tsanis, E.Chatzidakis, K.Kazdaglis<br />Neurosurgical Department,<br />General Hospital of Nikea - Piraeus, Athens, Greece<br />Brain catheterization for monitoring intracranial pressure, tissue oxygen and biochemistry. Series of54 patients.<br />
  2. 2. What’s the point in monitoring ?<br />Avoid secondary events causing ischemia<br />Early diagnosis of “late” hematomas <br />Early diagnosis of vasospasm in SAH <br />We need monitoring techniques :<br />easily, quickly and safely applied<br />easily interpreted<br />established alarm limits guiding treatment algorithms<br />
  3. 3. Intraparenchymal brain catheters (ICP, PbtiO2, Microdialysis, rCBF-TD)<br /> -Easy<br /> -Low infection rate<br /> -Transportable<br /> -Multimodal (ICP,CPP, CBF, Oxygenation &Metabolism)<br /> - “Invasive”<br /> - “Local”<br /> - Zero drift ~7-10 days<br />
  4. 4. “Invasive” “Local”<br />Very low complication rate and short learning curve for placement in almost all studies<br />- Harris CH et al. Placement of intracranial pressure monitors by non-neurosurgeons. Am Surg. 2002 Sep;68(9):787-90. <br /><ul><li>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.
  5. 5. Dings J et al. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery. 1998 Nov;43(5):1082-95.</li></ul>“Normal” frontal lobe white matter reflects global oxygenation and metabolism<br /> - Gupta AK et al Measurement of brain tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method.J Neurosurg. 2002 Feb;96(2):263-8. <br />Local may be advantageous in monitoring vulnerable tissue<br />- Sarrafzadeh AS, Sakowitz OW, Kiening KL, Benndorf G, Lanksch WR, Unterberg AW. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients?Crit Care Med.2002 May;30(5):1062-70<br />
  6. 6. Οur experience<br /> Multimodal neuromonitoring in 54 TBI or SCH patients using intraparenchymal brain catheters<br />Twist hand drill burr hole<br />Single same burr hole 5.3 mm<br />3 – lumen cranial bolt (LICOX)<br />ICP, PtiO2, microdialysis<br />Procedure bedside in ICU board<br />
  7. 7. Catheter’s tip<br />
  8. 8. Our experience from 54 cases<br />49 three lumen cranial bolt and 5 three lumen + Hemedex<br />No clinically significant infection in all cases<br />2 cases (3,7%): colonization with Staph. epidermidis without clinical significance<br />Contusion from insertion in 2 cases (3,7%)<br />&lt; 2 cm on CT, without neurological impact<br />Material failure (5,5%)<br />1 ICP<br />2 Microdialysis<br />
  9. 9. Contusion from catheter insertion<br />
  10. 10. Catheters’ tips placement<br />DAI patients<br />Non-dominant frontal lobe<br />Contusions<br />Penubra of the largest lesion<br />
  11. 11. Treatment strategies<br />CPP targeted therapy<br /> - CPP &gt; 60 mm Hg<br /> - ICP &lt; 20 mm Hg<br /> - PtiO2 &gt; 20 mm Hg<br /> - L / P ≤ 25 <br />
  12. 12. ICP and PtiO2 data determined the treatment. Microdialysis biochemistrydefined important clinical decisions concerning the management of certain cases.<br />
  13. 13. Conclusion<br />Multimodal neuromonitoring using intraparenchymalbrain catheters seems to be safe, reliable and clinically useful. <br />Catheterization procedure can be safely done on ICU bed. <br />Neuromonitoring data seems to correlate to outcome.<br />

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