New Approaches to Bedside Monitoring in Stroke
New Approaches to Bedside Monitoring in Stroke
External ventricular drain (EVD) is perhaps one of the most common methods to invasively measure ICP via an intraventricular catheter, which allows for diagnosis and treatment of raised ICP. Ventricular ICP measurement is considered a 'gold-standard' means for assessing elevations in global ICP, but it is invasive. EVDs also carry the risk of CNS infection such as meningitis/ventriculitis, like any other invasive brain probe, as well as risk of brain hemorrhage with EVD placement within the parenchyma. Antibiotic and silver-coated catheters are now in clinical use and may reduce the risk of infection.
Other types of ICP monitors exist, such as a Camino ICP monitor, which is basically a parenchymal ICP monitor, as well as subdural ICP monitors (Figure 3). Intraparenchymal monitors measure regional ICP, which can indicate global ICP issues assuming compartmental transmittance of ICP. Intraparenchymal monitors also contain the risk of measurement 'drift' over time as compared to a ventricular catheter. Subdural and subarachnoid catheters are sometimes placed via a screwed-in 'bolt apparatus' via a burrhole, similar to a simple hardware screw and bolt mechanism. There are newer devices that have a bolt-like apparatus with two ports to allow placement of different probes within its lumens.
(Enlarge Image)
Figure 3.
Artistic representation of various intracranial pressure monitoring sites. Invasive probes are placed at specific neuroanatomic positions such as the lateral ventricle, parenchymal tissue, and the subarachnoid and epidural space. Reprinted with permission from the Mayo Foundation for Research, all rights reserved.
Invasive ICP Measurement Methods
External ventricular drain (EVD) is perhaps one of the most common methods to invasively measure ICP via an intraventricular catheter, which allows for diagnosis and treatment of raised ICP. Ventricular ICP measurement is considered a 'gold-standard' means for assessing elevations in global ICP, but it is invasive. EVDs also carry the risk of CNS infection such as meningitis/ventriculitis, like any other invasive brain probe, as well as risk of brain hemorrhage with EVD placement within the parenchyma. Antibiotic and silver-coated catheters are now in clinical use and may reduce the risk of infection.
Other types of ICP monitors exist, such as a Camino ICP monitor, which is basically a parenchymal ICP monitor, as well as subdural ICP monitors (Figure 3). Intraparenchymal monitors measure regional ICP, which can indicate global ICP issues assuming compartmental transmittance of ICP. Intraparenchymal monitors also contain the risk of measurement 'drift' over time as compared to a ventricular catheter. Subdural and subarachnoid catheters are sometimes placed via a screwed-in 'bolt apparatus' via a burrhole, similar to a simple hardware screw and bolt mechanism. There are newer devices that have a bolt-like apparatus with two ports to allow placement of different probes within its lumens.
(Enlarge Image)
Figure 3.
Artistic representation of various intracranial pressure monitoring sites. Invasive probes are placed at specific neuroanatomic positions such as the lateral ventricle, parenchymal tissue, and the subarachnoid and epidural space. Reprinted with permission from the Mayo Foundation for Research, all rights reserved.
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