Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5-year experience.

OBJECTIVE

To assess the results of a 5-year experience with bedside burr hole for intracranial pressure (ICP) monitoring performed by intensive care physicians.

DESIGN

Prospective, observational study in 120 patients.

SETTING

A general-neurologic Intensive Care Unit in a University Hospital.

PATIENTS

Patients admitted for acute neural lesion requiring ICP monitoring.

METHOD

A 2.71 mm burr hole was made with positioning of a subarachnoid screw, through which a miniaturized fiberoptic, tip transducer device (Camino) was advanced and inserted 2 mm in the frontal cortex.

MAIN RESULTS

Over a 5-year period 120 patients, mainly with severe head trauma, underwent ICP monitoring. None of the planned patients was excluded because of technical difficulties. No life-threatening complications were reported, and the overall morbidity rate related to the ICP monitor was 3.3%. Complications were infectious in nature, with 2.5% wound infections and 0.8% meningitis. Although seven patients bled when opening the dura, no intracranial hematomas were recorded due to the ICP monitor. The fiberoptic device was left in place for 5 +/- 1.6 (SD) days (range 1-12 days). Five patients (4.1%) required catheter substitution due to breakage of the system components (fiberoptics).

CONCLUSIONS

Bedside insertion of a ICP monitor performed by intensive care physicians is a safe procedure, with a complication rate comparable to other series published by neurosurgeons. The overall morbidity rate is comparable to, or even lower than, that caused by central vein catheterization.