1. 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 Brain catheterization for monitoring intracranial pressure, tissue oxygen and biochemistry. Series of54 patients.
2. 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
5. 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 tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method.J Neurosurg. 2002 Feb;96(2):263-8. Local may be advantageous in monitoring vulnerable tissue - 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
6. 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
8. 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
10. Catheters’ tips placement DAI patients Non-dominant frontal lobe Contusions Penubra of the largest lesion
11. Treatment strategies CPP targeted therapy - CPP > 60 mm Hg - ICP < 20 mm Hg - PtiO2 > 20 mm Hg - L / P ≤ 25
12. ICP and PtiO2 data determined the treatment. Microdialysis biochemistrydefined important clinical decisions concerning the management of certain cases.
13. Conclusion Multimodal neuromonitoring using intraparenchymalbrain 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.
