Head Injury Trauma Clinical Trial
Official title:
Intracranial Pressure Monitoring in Sever Traumatic Brain Injury Single Centre Experience
Intracranial pressure (ICP) is defined as the pressure inside the skull, and therefore, the pressure inside the brain tissue and the cerebrospinal fluid (CSF). The relationship between CSF and intracranial blood volumes is described by the Monroe Kellie doctrine; because the brain is incompressible, when the skull is intact, the sum of the volumes of brain, CSF, and intracranial blood is constant.
ICP >15 mmHg is considered to be elevated, and this is considered an important cause of
secondary injury leading to irreversible brain injury and death. ICP monitoring is used in a
number of conditions; traumatic brain injury, intracerebral haemorrhage, subarachnoid
haemorrhage, hydrocephalus, malignant infarction, cerebral oedema, CNS infections, hepatic
encephalopathy, to name a few, and in all of these conditions ICP monitoring in the light of
other parameters can influence management for better outcomes.
There are 4 ways to monitor intracranial pressure:
1. An intra-parenchymal method, the catheter is placed into the brain parenchyma through a
burr hole; it has a lower complication rate, lower infection rate, and no chance of
catheter occlusion or leakage. Neurological injury is minimized because of the small
diameter of the probe. In addition, malposition of the transducer has less impact on
errors of measurement.
2. An intra-ventricular method, the catheter is placed into one of the ventricles (lat.
Ventricle). The catheter can also be used for therapeutic CSF drainage and for
administration of drugs.
3. Subdural method, this method is used if monitoring needs to be done right away. A hollow
screw is inserted through a burr hole and placed through the Dura mater.
4. An epidural sensor is inserted between the skull and dural tissue. This procedure is
less invasive than other methods.
ICP monitoring methods is associated with a number of complications. These include risk of
infection, haemorrhage, obstruction, difficulty in placement, malposition, etc.
The use of an ICP monitor is associated with significantly lower mortality when compared with
patients treated without an ICP monitor
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