Intracranial pressure monitoring by flaccid-cuff catheter in an animal model

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✓ Several methods of monitoring intracranial pressure (ICP) are in current use, each with its own advantages and disadvantages. The intraventricular line has been most useful because of the ability to withdraw cerebrospinal fluid to assist in control of elevated ICP. However, masses within the brain or generalized increased ICP may compress the lateral ventricle, making insertion of the catheter difficult or impossible. The intracerebral wick records hydrostatic changes too slowly to be used clinically. Swollen cerebral tissue may occlude the subarachnoid bolt thereby dampening the recorded pressure, and epidural monitors may give falsely high recordings because of irregularities of dura or bone. The authors have developed a flaccid-cuff catheter which has proven in animals to be an effective ICP monitor. There are several advantages, such as easy insertion into the centrum semiovale, rapid response to acute pressure changes, and continued sensitivity for periods of up to 3 weeks. The flaccid catheter cuff has no tension so that the pressure across the membrane is equal to zero, simplifying calibration. This type of cuff is necessary for maximum sensitivity to interstitial, brain-tissue, and gross ICP changes. The flaccid-cuff catheter may prove to be useful in a variety of situations such as after closed head trauma or intracranial surgery to assess elevated ICP caused by edema or evolving hematoma.

Article Information

Address reprint requests to: Jimmy D. Miller, M.D., Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: A flaccid balloon with inner catheter, inside an outer cannula, is passed into the white matter of the frontal lobe. B: The outer cannula is withdrawn leaving the balloon catheter in the centrum semiovale.

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    Comparison of baseline intracranial pressure recordings from the flaccid-cuff catheter (upper) and from an intraventricular line (lower).

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    Response of intracranial pressure to minimal jugular and abdominal compression as recorded by the flaccid-cuff catheter (upper) and a ventricular line (center). Arterial pressure is also shown (lower).

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    Comparison of pressure recordings from the flaccid-cuff (FC) monitor (upper) and an intraventricular line (center) in response to inflation and deflation of an intracerebral balloon for mass effect. The intracerebral balloon was placed ipsilateral to the intraventricular line and contralateral to the FC catheter. Arterial pressure is shown (lower).

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