Although CSF pressure may be measured during lumbar puncture, this method is of limited value in intracranial pressure measurement:
An isolated pressure reading does not indicate the trend or detect pressure waves. Lumbar puncture is contraindicated in the presence of an intracranial mass. Pressure gradients exist between different intracranial and spinal compartments, especially in the presence of brain shift.
Many techniques are now available to measure intracranial pressure, including a fibre-optic transducer (Camino) inserted into the brain surface, or extra or intradural devices measuring pressure on the hemisphere surface, but a catheter inserted into the lateral ventricle remains the standard by which other methods are compared.
A ventricular catheter is inserted into the frontal horn of the lateral ventricle through a frontal burr hole or small drill hole situated two finger breadths from the midline, behind the hairline and anterior to the coronal suture.
2 finger breadths
Intracerebral haemorrhage following catheter insertion rarely occurs.
Ventriculitis seldom occurs provided monitoring does not continue for more than three days.
In the lateral plane, the catheter is directed towards the external auditory meatus
Transducer Chart recorder
In the AP plane, the catheter is directed towards the Inner canthus
2 finger breadths
The saline filled catheter is connected to a pressure transducer and the ICP recorded on a chart recorder
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