Introduction: Intracranial Pressure (ICP) monitoring is an important tool in the neurosurgeon’s armamentarium. There are plenty of different ICP monitors available of which fibre-optic intraprenchymal devices are one of the most popular. Here we document our experience of ICP monitoring in the craniofacial department at the John Radcliffe hospital between 2005 and 2015.
Methods: A retrospective review was performed of the medical records of all paediatric craniofacial patients under going intracranial pressure monitoring at the John Radcliffe Hospital over the past 10 years. All patients had a Codman MicroSensorTM intraparenchymal ICP monitor (Johnson & Johnson Professionals, Inc.) inserted under general anaesthetic. A twist-drill burr hole was placed at Kocher's point and a tunnelled ICP monitor was inserted, coiled and secured to the scalp.ICP recording was performed using Powerlab chart (ADI instruments). An average ICP over 15mm Hg or more than 3 B-type waves in 24-hour period during sleep was classified as raised. Statistical analysis was performed using the Minitab statistical software package (version 16; Minitab Inc.).
Results: There were 385 separate operations with an overall complication rate of 8.3% (32/227). Hardware failure occurred in 4.2% of cases, CSF leak rate was 3.6%, postoperative haemorrhage was 0.5% and there was 1 infected case (0.3%). Only patients with hardware problems required further surgery as a result of their complication and no patients experienced any permanent morbidity or mortality. Younger patients (p=0.001) and patients with pathologically high ICP (13% c.f. 6.5%, p=0.04) were significantly more likely to suffer complications. There was no significant difference in complication rate between general neurosurgical patients and craniosynostosis patients (7.6% c.f. 8.8%, p=0.67).
Conclusions: Intraparenchymal ICP monitoring is a safe procedure associated with low morbidity in the paediatric population. We suggest that it should be used with the reassurance of our safety profile, especially in the evaluation of patients with craniosynostosis.
Patient Care: Our results report the safety profile of the Codman MicroSensor ICP monitor. We have quantified the complication rate and have shown that it is associated with low morbidity and no mortality. Intraparenchymal ICP monitoring is a safe procedure and should be utilised more frequently in the craniofacial population, especially when conservative management is planned.
Learning Objectives: By the conclusion of this session, participants should be able to: By the conclusion of this session, participants should be able to: 1) Describe the complications following ICP monitor insertion 2) Discuss, in small groups, the usefulness of ICP monitoring, especially in evaluation of craniosynostosis.