颅内压监测

定义

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

选择的名字

ICP monitoring; CSF pressure monitoring

如何执行测试

监测ICP有三种方法. 颅内压是颅骨的压力. These procedures are most often done on people with life-threatening neurological emergencies.

脑室导管

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 cerebrospinal fluid (CSF). CSF is a liquid that protects the brain and spinal cord.

The intraventricular catheter can also be used to drain fluid out through the catheter.

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

硬膜下螺钉(螺栓)

This method is used if monitoring needs to be done right away. A hollow screw 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.

硬膜外传感器

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.

• 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.

如何准备考试

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. 你得签一份同意书.

考试的感觉如何

如果这个过程是用 全身麻醉，你就会睡着，没有痛苦. 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 like 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 provider may give you mild pain medicines to ease your discomfort. 你可能吃不到强效止痛药, because your provider will want to check for signs of brain function.

为什么要进行测试

This test is most often done to measure ICP. 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 ICP can be treated by draining CSF through the catheter. 它也可以通过以下方式治疗:

• Changing the ventilator settings for people who are on a respirator
• Giving certain medicines through a vein (intravenously)

正常的结果

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

Talk to your provider about the meaning of your specific test results.

异常结果意味着什么

High ICP 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.

风险

手术过程中的风险包括:

• 出血
• 脑疝 或者因为压力增加而受伤
• 对脑组织的损伤
• Inability to find the ventricle and place catheter
• 感染
• 全身麻醉的风险

参考文献

DiGiorgio AM, Huang MC, Wang VY, Manley GT. 颅内压监测. In: win HR, ed. Youmans和Winn神经外科. 8日艾德. Philadelphia, PA: Elsevier; 2023:chap37.

Oddo M, Taccone F. 颅内压监测. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. 重症监护教材. 8日艾德. Philadelphia, PA: Elsevier; 2024:chap E20.

拉宾斯坦AA，布拉克西克SA. Neurointensive保健. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8日艾德. Philadelphia, PA: Elsevier; 2022:chap 53.

Robba C. 颅内压监测. 见:Prabhakar H, ed. Neuromonitoring技术. Philadelphia, PA: Elsevier; 2018:chap 1.