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    Intracranial pressure monitoring

    ICP monitoring; CSF pressure monitoring

    Intracranial pressure monitoring uses a device, placed inside the head. The monitor senses the pressure inside the skull and sends measurements to a recording device.

    How the Test is Performed

    There are three ways to monitor pressure in the skull (intracranial pressure).

    INTRAVENTRICULAR CATHETER

    The intraventricular catheter is the most accurate monitoring method.

    To insert an intraventricular catheter, a hole is drilled through the skull. The catheter is inserted through the brain into the lateral ventricle. This area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal cord.

    The intracranial pressure (ICP) can at the same time as monitoring by draining fluid out through the catheter.

    The catheter may be hard to get into place when the intracranial pressure is high.

    SUBDURAL SCREW

    This method is used if monitoring needs to be done right away. A hollow screw that is inserted through a hole drilled in the skull. It is placed through the membrane that protects the brain and spinal cord (dura mater). This allows the sensor to record from inside the subdural space.

    EPIDURAL SENSOR

    An epidural sensor is inserted between the skull and dural tissue. The epidural sensor is placed through a hole drilled in the skull. This procedure is less invasive than other methods, but it cannot remove excess CSF.

    Lidocaine or another local anesthetic will be injected at the site where the cut will be made. You will most likely get a sedative to help you relax.

    • First the area is shaved and cleansed with antiseptic.
    • After the area is dry, a surgical cut is made. The skin is pulled back until the skull is seen.
    • A drill is then used to cut through the bone.

    How to Prepare for the Test

    Most of the time, this procedure is done when a person is in the hospital intensive care unit. If you are awake and aware, your health care provider will explain the procedure and the risks. You will have to sign a consent form.

    How the Test Will Feel

    If the procedure is done using general anesthesia, you will be asleep and pain-free. When you wake up, you will feel the normal side effects of anesthesia. You will also have some discomfort from the cut made in your skull.

    If the procedure is done under local anesthesia, you will be awake. Numbing medicine will be injected to the place where the cut is to be made. This will feel a prick on your scalp like a bee sting. You may feel a tugging sensation as the skin is cut and pulled back. You will hear a drill sound as it cuts through the skull. The amount of time this takes will depend on the type of drill that is used. You will also feel a tugging as the surgeon sutures the skin back together after the procedure.

    Your health care provider may give you mild pain medicines to ease your discomfort. You will not get strong pain medicines, because your doctor will want to check for signs of brain function.

    Why the Test is Performed

    This test is most often done to measure intracranial pressure. It may be done when there is a severe head injury or brain/nervous system disease. It also may be done after surgery to remove a tumor or fix damage to a blood vessel if the surgeon is worried about brain swelling.

    High intracranial pressure can be treated by draining CSF through the catheter. It can also be treated by changing the ventilator settings for people who are on a respirator, or by giving certain medicines through a vein (intravenously).

    Normal Results

    Normally, the ICP ranges from 1 to 20 mm Hg.

    Note: mm Hg = millimeters of mercury

    Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

    What Abnormal Results Mean

    High intracranial pressure means that both nervous system and blood vessel tissues are under pressure. If not treated, this can lead to permanent damage. In some cases, it can be life-threatening.

    Risks

    • Bleeding
    • Brain herniation or injury from the increased pressure
    • Damage to the brain tissue
    • Inability to find the ventricle and place catheter
    • Infection
    • Risks of general anesthesia

    References

    Rabinstein AA. Principles of neurointensive care. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 45.

    Raboel PH, Bartek J Jr, Andresen M, Bellander BM, Romner B. Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods—A Review. Critical Care Research and Practice. 2012.

    Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012:367:2471-2481.

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            Tests for Intracranial pressure monitoring

            Review Date: 5/28/2013

            Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network.

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