Methods of intracranial pressure monitoring

Intracranial pressure can be monitored from the intraventricular, intraparenchymal, subarachnoid, subdural, and epidural compartments. Intraventricular monitors include ventriculostomy catheters and ventriculostomy catheters equipped with catheter-tip transducers. Ventriculostomy catheters are fluid coupled to external strain gauge pressure transducers. They are maintained at the level of the external auditory meatus for accurate pressure readings. They offer the ability for recalibration after insertion and replacement of pressure transducers if a malfunction occurs. Importantly, therapeutic cerebrospinal fluid drainage is possible with these devices. Ventriculostomy with catheter-tip pressure transducers employs advanced fiber-optics which is significantly more expensive. Ventricular canalization may be difficult in the case of 'slit ventricles', and catheters are occasionally obstructed with blood clot or tissue.

Intraparenchymal catheter-tip pressure transducers include fiber-optic devices such as the Camino device and recently introduced miniature strain gauge transducers

(GopinatheLa/ 1995). These devices are zeroed to atmospheric pressure prior to insertion and recalibration is not possible. Fiber-optic devices have been shown to drift significantly during prolonged monitoring. Miniature strain gauge devices have less tendency to drift ( Gopinath.ef a/ 1995). Additionally, the fiber-optic catheters are brittle and have a tendency for decreased longevity in the intensive care setting. Subarachnoid or subdural fluid-coupled devices and epidural devices are less accurate (Bullock.. .§.LêL 1996). The primary indication for their use is in patients with a prohibitively high risk of hemorrhage complications such as liver transplant candidates (Keaysefa/ 1993). In summary, the ventriculostomy catheter connected to an external strain gauge transducer is relatively inexpensive and provides the most accurate and reliable method for intracranial pressure monitoring. Additionally, it allows therapeutic drainage of cerebrospinal fluid. Parenchymal pressure tip transducers provide similar intracranial pressure data but are not as reliable owing to drift and the inability to recalibrate.

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