Introduction: The use of the Camino Intracranial Pressure Monitor (Integra, Plainsboro, NJ) is common in both pediatric and adult patients when there is a concern of an increase in intracranial pressure. The device comes with a spacer for use in pediatric patients to prevent the surgeon from inserting the device too deep within the skull (Figure 1). The spacer is not used in a consistent way between providers.

Methods: A review of a pediatric patient case was performed.

Results: A female patient, age 8, presented with CT imaging findings that suggested an increase in ICP. ICP monitoring was recommended. The Camino device was placed with the spacer via a small scalp incision (10mm) by an attending neurosurgeon. Intracranial pressure was not elevated, therefor the device was removed by a neurosurgical resident. Three months later, she presented with a palpable subcentimeter mass under her left frontal scalp incision. The foreign body was identified as the spacer from the Camino device, which had been left behind when the device was removed after her ICP monitoring three months earlier.

Conclusions: Surgeons can use the Camino spacer as intended, remove it, or place it outside the scalp to tamponade the scalp edges. At our hospital there were no standards in place regarding the use of the spacer and no documentation of whether or not the spacer was placed in the subgaleal space. The options to prevent this from happening again included trying to develop a system where better documentation of placement and removal of the device or to simply stop using the spacer in all cases. Neurosurgical programs with multiple providers should have a standard practice regarding the use (or non-use) of the spacer to avoid this preventable complication

Patient Care: Help hospitals avoid a preventable complication with the use of the Integra Camino ICP monitor.

Learning Objectives: 1. Integra Camino intraparenchymal intracranial pressure monitor contains a pediatric spacer that has variable use. 2. Our hospital did not have set standards in place regarding the use of the spacer nor documentation of whether or not the spacer was placed. 3. Neurological surgeons should have a set standard practice regarding the us (or non-use) of the spacer to avoid a preventable complication.

References: 1. Xuan Zhang et al. Invasive and noninvasive means of measuring intracranial pressure: a review. 2017 Physiol. Meas. 38 R143 2. Bekar, A, Dogan, S, Abas, F, Caner, B, Korfali, G, Kocaeli, H, Yilmazlar, S, Korfali, E. Risk factors and complications of intracranial pressure monitoring with a fiberoptic device. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, ISSN: 0967-5868, Vol: 16, Issue: 2, Page: 236-40. 2009. 10.1016/j.jocn.2008.02.008 3. Integra Manual: Surgical technique https://www.integralife.com/file/general/1453795633-2.pdf 4. Anderson RCE, Kan P, Klimo P, Brockmeyer DL, Walker ML, Kestle JR (2004) Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg (Pediatrics) 101: 53–58