Insert catheter into parenchyma to measure intracranial pressure

Increased intracranial pressure is an extremely dangerous condition, affecting the life of patients, often appearing in the context of traumatic brain injury. To be able to monitor the disease progression as well as the treatment process, it is extremely important to surgically place the catheter into the parenchyma to measure intracranial pressure.

Increased intracranial pressure is a condition in which the pressure of the skull as well as other internal structures such as the brain, blood, and cerebrospinal fluid system is increased, often seen in many different diseases such as cerebral dilatation. ventricles, brain tumors, cerebral encephalopathy, cerebral edema, and most dangerously in traumatic brain injury.
Increased intracranial pressure is an extremely dangerous condition, requiring prompt treatment, otherwise it can lead to serious consequences such as nerve damage, cerebral ischemia, brain stem herniation , can even lead to death.
Elevated intracranial pressure is also one of the last developments in neurosurgery in some patients, the possibility of increased intracranial pressure often affects the good or bad outcome of the surgery. Therefore, if it is detected that increased intracranial pressure occurs, it is necessary to quickly intervene and properly handle it.
To be able to capture and monitor increased intracranial pressure as quickly as possible, measuring intracranial pressure plays a huge role. If doctors and medical personnel can continuously monitor the patient's intracranial pressure, the detection and treatment of raised intracranial pressure will be more favorable. When monitoring the patient's intracranial pressure, it is possible to adjust and maintain the perfusion pressure to the brain in the most appropriate way. In addition, measuring intracranial pressure can also serve as a basis for future treatment, which can be medical treatment such as using 3% sodium chloride, mannitol, diuretics... or technical measures such as open surgery. ventricular catheterization or drainage of cerebrospinal fluid... After the raised intracranial pressure is controlled and returned to a stable level, the measurement of intracranial pressure may be indicated to stop in the patient.

Up to now, there are two types of intracranial pressure gauges most commonly used, which are the ventricular parenchymal catheter and the microchip sensor. If measuring intracranial pressure with a microchip sensor cannot be adjusted inside the patient's body, placing a catheter in the parenchyma to measure intracranial pressure allows the drainage of cerebrospinal fluid as well as drug administration. intraventricular to treat raised intracranial pressure.
More specifically, to carry out Catheter placement in the brain parenchyma to measure intracranial pressure, the following indications must be followed:
Patients after examination are diagnosed with severe traumatic brain injury, the Glasgow score is smaller. 8 and there is no indication for surgery. Patients with severe traumatic brain injury are at increased risk of hematoma. Patients after surgery to remove the hematoma and have accompanying lesions that lead to some other parts being damaged. Patients with moderate ventricular dilatation need to be monitored with catheters to consider the indications for ventricular drainage. Contraindications of surgical catheterization are patients who are taking anticoagulants or have a history of hemophilia or hemophilia.
The steps to conduct the method of placing Catheter to measure intracranial pressure are as follows:

Confirm the patient's diagnosis with some necessary paraclinical tests to assess the patient's general condition before surgery. Fully explain the techniques that will be performed to the patient and family, and also explain the possibility of surgery as well as unwanted complications that may occur after surgery. Prepare necessary machines and equipment such as intracranial pressure measurement kits, specialized neurosurgery tools, fluids, drugs... Place the patient in a supine position, head up. 1 angle 15°- 20°. Perform endotracheal anesthesia. Incision of the patient's skin in the area of ​​0.3cm - 0.5cm in front of the right frontal-parietal joint with an incision size of about 2cm to expose the skull. Drilling on the skull has exposed a hole with a specialized surgical drill, paying attention to the preparation of the stopper to prevent the drill from hitting the dura. Use screws to fix the skull, the outer end of the skull and fix the Catheter to the skull. Adjust the Catheter to zero before it is inserted into the brain parenchyma. Use a special needle to open the dura. Slowly insert the sensor tip catheter into the brain parenchyma, connect the drain, and then fix the catheter to the screw. Close the skin incision. Clean and bandage the wound. After the technique of placing Catheter to measure intracranial pressure, it is necessary to monitor vital signs including pulse, breathing rate, blood pressure, temperature... as well as signs related to nerves. Some complications that can be encountered after surgery are bleeding, infection causing meningitis or encephalitis. Therefore, it is necessary to closely monitor the patient's condition after surgery to promptly apply measures such as hemostasis, blood transfusion, giving the patient anti-epileptic drugs, meningeal puncture to culture bacteria, treat Treatment of encephalitis, meningitis with antibiotics, if sinusitis occurs, it is necessary to re-operate to aspirate pus, clean the wound and treat the patient with antibiotics.
Increased intracranial pressure is considered an emergency in dangerous medical conditions such as ventricular dilatation, traumatic brain injury... so it should be handled and intervened as soon as possible. Measuring intracranial pressure by placing catheters into the ventricles makes it easier to monitor and adjust intracranial pressure, thereby effectively treating raised intracranial pressure.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in neurological examination and treatment, patients can completely peace of mind to examine and treat raised intracranial pressure at the Hospital.
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