Comparison of Ventricular Type and Parenchymal Type Intracranial Pressure (ICP) Monitoring for the Severe Traumatic Brain Injury Patients

Abstract

Objective: Intracranial pressure (ICP) is one of the critical parameter for the patients of severe traumatic brain injury (TBI) to determine the treatment modalities and predict clinical outcomes. Hence, the ICP monitoring with accuracy and safety is essential for the TBI patients. The purpose of this study is to compare its safety and clinical usefulness of intraventricular ICP monitoring method to the parenchymal type.

Methods: We retrospectively reviewed the medical records and imaging data of 18 severe TBI patients. We used intraventricular ICP monitoring in 10 patients and parenchymal 8 patients. We compared the clinical findings of the two type ICP monitoring methods including procedure time, neurological status, outcome, complications and mortality.

Results: The initial Glasgow Coma Scale of intraventricular ICP monitoring and parenchymal ICP monitoring patients were 5.8 (range: 4-7) and 6.5 (range: 3-7) respectively. The Glasgow Outcome Scale after 6 months was a little higher in intraventricular monitoring patients than parenchymal monitoring patients (2.8 vs. 2.0, p=0.25). We could not find any intraventricular catheter related complication in intraventricular ICP monitoring patients. There was no difference in mortality in both groups (p=0.56).

Conclusion: Our results suggest that intraventricular catheter insertion for ICP monitoring is relatively a safe procedure in the severe TBI patients. We could not demonstrate the significant benefit of intraventricular type ICP monitoring compared with parenchymal type ICP monitoring. Considering intraventricular type ICP monitoring have advantages of the accuracy and extraventricular drainage, intraventricular type ICP monitoring could be considered for severe TBI patients, regardless of hydrocephalus.