Name:
03 Intracranial Pressure Monitor Insertion
Description:
03 Intracranial Pressure Monitor Insertion
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/d0a5fc82-e7d0-4022-9a90-60d395fb4445/thumbnails/d0a5fc82-e7d0-4022-9a90-60d395fb4445.jpg?sv=2019-02-02&sr=c&sig=2UzMfwz369fY8Gaw2PeI5chOgtuTZLxdh8Xr%2BJ5eXnc%3D&st=2024-12-21T14%3A15%3A11Z&se=2024-12-21T18%3A20%3A11Z&sp=r
Duration:
T00H06M11S
Embed URL:
https://stream.cadmore.media/player/d0a5fc82-e7d0-4022-9a90-60d395fb4445
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/d0a5fc82-e7d0-4022-9a90-60d395fb4445/0320Intracranial20Pressure20Monitor20Insertion.mov?sv=2019-02-02&sr=c&sig=CGaoYnfotz9xLwqXDTYr1y4ZwUwyEx%2BpgvF9a37eGbQ%3D&st=2024-12-21T14%3A15%3A11Z&se=2024-12-21T16%3A20%3A11Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
In this video we will discuss the proper technique to placing an intracranial pressure monitoring device.
Segment:1 Objectives.
We will begin by discussing the relevant anatomy, the instruments and positioning, exposure and techniques, and, finally, the tips and pitfalls of this procedure.
Segment:2 Anatomy.
There are several surface anatomy landmarks which will help identify the proper position to place the intracranial pressure monitor. The first landmark is the sagittal line, which runs anterior to posterior over the head, extending from the base of the nose and the midline.
The second landmark is mid-pupillary line, extending from anterior to posterior, starting at the midpoint of the pupil. Next is the coronal suture, which runs transversely across the head and may be palpated approximately 10-12 cm posterior to the base of the nose. With all of these landmarks identified, the optimal location for placement of an intracranial pressure monitor is located, known as Kocher's point. Kocher's point is located along the mid-pupillary line, 2-3 cm lateral to the sagittal line and 2 cm anterior to the coronal suture.
Note that the intracranial pressure monitor should be placed on the patient's non-dominant hemisphere, which, in the majority of people, is on the right side. There are two major types of intracranial pressure monitors those which allow only for monitoring of pressure, and intraventricular monitors, or extraventricular drains, which allow for monitoring, as well as therapeutic drainage of cerebrospinal fluid. Intracranial pressure monitors are designed to be placed at various levels, including the subdural space, intraparenchymal, and the epidural space.
The advantages of these monitoring-only devices is that they allow for continuous monitoring, are easy to place and have a decreased infection rate. The disadvantages are that they offer no therapeutic modality and they are less accurate. The intraventricular monitor, or extraventricular drain, is placed into the ventricle and offers the advantages of accurate monitoring and therapeutic drainage of cerebrospinal fluid. However, they require more skill to place and are associated with a higher rate of infection.
Segment:3 Instruments and Positioning.
The patient is positioned supine with the head elevated, or in a reverse Trendelenburg position to 30 degrees, and the head immobilized in a neutral position. The hair is clipped and the scalp prepped surrounding Kocher's point. There are several commercially available intracranial monitoring kits available for the various types of monitors. The patient is positioned and the head immobilized, seen here with tape. The surface landmarks are palpated and marked, beginning with the sagittal line, running anterior to posterior from the base of the nose.
Next, the coronal suture is palpated and marked, running transversely approximately 10-12 cm posterior from the base of the nose. The mid-pupillary line is marked. And, finally, Kocher's point is marked along the mid-pupillary line, 2-3 cm lateral to the sagittal line and 2 cm anterior to the coronal suture.
Local anesthesia is given. A scalpel is then used to make a 1 cm incision in the scalp to the outer table of the skull at Kocher's point. The drill is then placed in the incision and positioned in a trajectory, aiming for the point approximated by the ipsilateral medial canthus of the eye, and the tragus of the ear.
The outer table of the skull is drilled in a steady, continuous fashion, maintaining the previously mentioned trajectory. Sterile saline is used intermittently to clean bone fragments from both the drill and burr hole in order to maintain steady progress. Once the outer table is penetrated, the drill will progress in a more rapid fashion through the marrow before, once again, becoming tough as the inner table is drilled. The drill in most available kits contains a guard to prevent inadvertent slippage of the drill into the parenchyma of the brain as the drill penetrates the inner table.
A probe is used to confirm that both tables of the skull have been penetrated by the drill. The intraventricular catheter is then placed in the same trajectory, approximated by the tragus and medial canthus. The stylus is removed and positioning is confirmed by the return of CSF. It is recommended that the catheter be tunneled, using a tunneling device in subcutaneous tissue, and brought out a separate stab incision as this will decrease the chance for infection.
A luer lock adaptor is then connected and the external ventricular drain may now be connected to the drainage system. The incision is then sutured and the catheter is secured to the scalp in order to prevent migration.
Segment:4 Tips and Pitfalls.
Intraventricular pressure monitors should be placed in the non-dominant hemisphere of the patient, which in most patients is the right side. If the ventricles are compressed or displaced secondary to mass effect, a non-intraventricular monitor should be placed.
Contraindications include coagulopathy, bleeding diathesis, and intraventricular hemorrhage. Avoid excessive CSF loss during the procedure, as sudden decompression of the ventricles can be harmful to the patient. Thank you.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
