Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyClinical evaluation of the Codman microsensor intracranial pressure monitoring system.
The use of the Camino fibre-optic subdural device for measuring Intracranial Pressure (ICP) in patients, has been shown to correlate well with recordings from the "gold standard" intraventricular fluid filled catheter [1]. Following this work, its use has become standard in the clinical monitoring of patients. More recently, laboratory studies have demonstrated accuracy, acceptable drift and high fidelity for the new Codman Microsensor ICP Transducer, a miniature strain gauge mounted on a flexible nylon catheter [3]. Its performance in patients, however, has yet to be fully assessed, in comparative studies. ⋯ These differences could in the majority of cases (excepting the negative drift) be explained by a constant offset of the Codman transducer, as described previously [6]. Further examination of this device is required.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyAn avoidable methodological failure in intracranial pressure monitoring using fiberoptic or solid state devices.
Failure of intraventricular pressure (IVP) measurement in case of catheter blockage is believed to be eliminated by using intraventricular microtransducers. We report about an avoidable methodological error, which may affect the reliability of IVP measurement with these devices. Intraventricular fiberoptic or solid state devices were implanted in 43 patients considered to be at risk for catheter occlusion. ⋯ In patients treated with Type B devices, no erroneous pressure recording could be identified, irrespective if CSF drainage was performed or not. Transducers, which are simply placed inside the ventriculostomy catheter require fluid coupling. They may fail, either during CSF drainage or when the catheter is blocked or placed within the parenchyma.
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Severe head injury with and without peripheral trauma is the most frequent cause of death and of severe disability up to 45 years. Outcome is determined by two major factors, the extent and nature of the irreversible primary brain damage, and the evolving secondary sequelae, which contrary to the former are responsive in principle to therapeutic intervention. An improvement of outcome from severe head injury can be expected only from an increased efficiency of the measures to prevent secondary brain damage. ⋯ Current results and experiences with establishment of this comprehensive research organization are presented, where no less than 31 hospitals. Institutions and organizations, and a study group of more than 40 physicians, students and statisticians are collaborating. Emerging data appear to be suitable to further improve pertinent aspects of the patient management as a basis to lower the incidence of secondary brain damage from severe head injury.
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Acta Neurochir. Suppl. · Jan 1998
Morphological and hemodynamic evaluations by means of transcranial power Doppler imaging in patients with severe head injury.
The following conditions of 17 patients with severe head injury (ages 9-76; mean 37:12 focal and 5 diffuse injuries) were evaluated during acute phase (1-14 days after injury, mean 5) by transcranial power Doppler imaging (PDI), a new color Doppler ultrasound technique: a) morphological changes via temporal window, b) hemodynamic changes in major intracranial/cervical arteries based on measured angle-corrected time-averaged mean (TAM)/ peak velocities and vessel diameter (Va), and calculated pulsatility indices (PI), vessel area (Va), and flow volume (Vf = TAM x Va). a) 1) Major trunks of intracranial vessels and circle of Willis and pathological changes in frontal/temporal lobes and midbrain were finely visualized. 2) Contusional hemorrhage and cerebral contusion demonstrated irregular hyper- and hypo-echoic lesions, respectively. 3) Delayed epidural hematoma showed a hyper-echoic band. b) 1) Decreased velocities, significant PI increase, and Va increase tendency were observed in intracranial arteries. 2) Increased velocities with Vf increase but no Va decrease indicated hyperemia rather than vasospasm. 3) Va in the intracranial vessels, however, tended to increase PDI appears useful in evaluating real-time and simultaneous morphological and hemodynamic information in pathogenesis and neurointensive care of patients with severe head injury.
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Acta Neurochir. Suppl. · Jan 1998
Complications and safety associated with ICP monitoring: a study of 542 patients.
In our institution ICP was monitored in patients with GCS < or = 8 and abnormal CT scan: 362 severely head injured and 180 subarachnoid hemorrhage. Mean duration of monitoring was 103.6 hours (SD 74.96). Among 542 patients, 440 showed at least one episode of ICP above the threshold of 20 mm Hg. ⋯ In 13 cases (2.2%) a ventricular infection has been diagnosed. In 1 case an intraparenchimal hemorrhage related to the presence of the catheter was detected. Elevated risk of HICP and low incidence of complications have been shown in this series.