“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.
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 />
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 />
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 />< 2 cm on CT, without neurological impact<br />Material failure (5,5%)<br />1 ICP<br />2 Microdialysis<br />
Catheters’ tips placement<br />DAI patients<br />Non-dominant frontal lobe<br />Contusions<br />Penubra of the largest lesion<br />
Treatment strategies<br />CPP targeted therapy<br /> - CPP > 60 mm Hg<br /> - ICP < 20 mm Hg<br /> - PtiO2 > 20 mm Hg<br /> - L / P ≤ 25 <br />
ICP and PtiO2 data determined the treatment. Microdialysis biochemistrydefined important clinical decisions concerning the management of certain cases.<br />
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 />