Summary The aim of this study was to evaluate the effect of ventriculostomy on intracranial pressure (ICP), and related parameters, including cerebrospinal compensation, cerebral oxygenation (PbtO2) and metabolism (microdial-ysis) in patients with traumatic brain injury (TBI).
Materials and methods Twenty-four patients with paren-chymal ICP sensors were prospectively included in the study. Ventriculostomy was performed after failure to control ICP with initial measures. Monitoring parameters were digitally recorded before and after ventriculostomy and compared using appropriate tests.
Results In all patients ventriculostomy led to rapid reduction in ICP. Pooled mean daily values of ICP remained <20mmHg for 72h after ventriculostomy and were lower than before (p < 0.001). In 11 out of 24 patients during the initial 24-h period following ventriculostomy an increase in ICP to values exceeding 20mmHg was observed. In the remaining 13 patients ICP remained stable, allowing reduction in the intensity of treatment. In this group ventriculostomy led to significant improvement in craniospinal compensation (RAP index), cerebral perfusion pressure and PbtO2. Improvement in lactate/pyruvate ratio, a marker of energy metabolism, was correlated with the increase in PbtO2.
Conclusion Ventriculostomy is a useful ICP-lowering manoeuvre, with sustained ICP reduction and related physiological improvements achieved in >50% of patients.
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References
Anderson RC, Kan P, Klimo P, Brockmeyer DL, Walker ML, Kestle JR (2004) Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 101: 53–58
Baldwin HZ, Rekate HL (1991) Preliminary experience with controlled external lumbar drainage in diffuse pediatric head injury. Pediatr Neurosurg 17:115–120
Balestreri M, Czosnyka M, Steiner LA, Schmidt E, Smielewski P, Matta B, Pickard JD (2004) Intracranial hypertension: what additional information can be derived from ICP waveform after head injury? Acta Neurochir (Wien) 146:131–141
Brain Trauma Foundation (2007) Guidelines for the management of severe traumatic brain injury (3rd edition). J Neurotrauma 24 (s1):S1–S106
Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821
Ford R, Spatz EL (1960) Post-traumatic obstruction of the aqueduct of Sylvius and postdecompression cerebral edema treated by ventriculostomy. N Engl J Med 263:263–267
Fortune JB, Feustel PJ, Graca L, Hasselbarth J, Kuehler DH (1995) Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury. J Trauma 39:1091–1097 (discussion 1097–1099)
Fritsch MJ, Moss SD, Beyda DH, Manwaring KH (1997) Controlled external lumbar drain as treatment for therapy resistant intracranial hypertension—case report. Zentralbl Neurochir 58:192–195
Ghajar JBG, Hariri RJ, Patterson RH (1993) Improved outcome from traumatic coma using only ventricular cerebrospinal fluid drainage for intracranial pressure control. Adv Neurosurg 21:173–177
Guyot LL, Dowling C, Diaz FG, Michael DB (1998) Cerebral monitoring devices: analysis of complications. Acta Neurochir Suppl 71:47–49
Holloway KL, Barnes T, Choi S, Bullock R, Marshall LF, Eisenberg HM, Jane JA, Ward JD, Young HF, Marmarou A (1996) Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 85:419–424
Hutchinson PJ, Hutchinson DB, Barr RH, Burgess F, Kirkpatrick PJ, Pickard JD (2000) A new cranial access device for cerebral monitoring. Br J Neurosurg 14:46–48
Kerr ME, Weber BB, Sereika SM, Wilberger J, Marion DW (2001) Dose response to cerebrospinal fluid drainage on cerebral perfusion in traumatic brain-injured adults. Neurosurg Focus 11: E1
Khan SH, Kureshi IU, Mulgrew T, Ho SY, Onyiuke HC (1998) Comparison of percutaneous ventriculostomies and intraparen-chymal monitor: a retrospective evaluation of 156 patients. Acta Neurochir Suppl 71:50–52
Levy DI, Rekate HL, Cherny WB, Manwaring K, Moss SD, Baldwin HZ (1995) Controlled lumbar drainage in pediatric head injury. J Neurosurg 83:453–460
Lundberg N, Troupp H, Lorin H (1965) Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 22:581–590
Marmarou A, Maset AL, Ward JD, Choi S, Brooks D, Lutz HA, Moulton RJ, Muizelaar JP, DeSalles A, Young HF (1987) Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients. J Neurosurg 66:883–890
Menon DK (1999) Cerebral protection in severe brain injury: physiological determinants of outcome and their optimisation. Br Med Bull 55:226–258
Ruchholtz S, Waydhas C, Muller A, Lewan UM, Nast-Kolb D, Euler E, Pfeiffer KJ, Schweiberer L (1998) Percutaneous computed tomographic-controlled ventriculostomy in severe traumatic brain injury. J Trauma 45:505–511
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Timofeev, I. et al. (2008). Ventriculostomy for control of raised ICP in acute traumatic brain injury. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_20
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DOI: https://doi.org/10.1007/978-3-211-85578-2_20
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