Management of patients with severe traumatic brain injury guided by intraventricular intracranial pressure monitoring: a report of 136 cases

Abstract

Objective: To evaluate the effect of the treatment modality guided by intraventricular intracranial pressure (ICP) monitoring on patients with severe traumatic brain injury (TBI).

Methods: The clinical data of a group of 136 severely brain-injured patients admitted to Shanghai Neurosurgical Emergency Center from December 2004 to February 2006 were studied.

Results: The intraventricular ICP monitor was placed in all the 136 patients via Kocher's pathway, Paine's pathway or intraoperative opened ventricle. In this series, the probe was placed during the procedure of craniotomy in 98 patients; for other 38 patients, the probe was placed initially to measure or to monitor ICP. A stepwise protocol targeting at ICP control (less than or equal to 20 mm Hg) and optimal cerebral perfusion pressure (CPP) maintenance (60-90 mm Hg) was deployed. Among them, 76 patients survived with good recovery, 14 with moderate disability, 24 with severe disability, 10 with vegetative state, and 12 died. Complications associated with intraventricular ICP monitoring included hemorrhage and infection. Hemorrhage occurred in 1 patient and infection in 5 patients. There were no unacceptable complications related to ICP monitoring.

Conclusions: Ventricular access for ICP monitoring can be safely and accurately achieved. ICP monitoring via ventriculostomy may facilitate an early and accurate intervention for severely brain-injured patients. The intraventricular ICP monitoring is a low-risk procedure and can yield great benefits for management of patients with severe TBI.