Ventriculostomy for control of raised ICP in acute traumatic brain injury.
The aim of this study was to evaluate the effect of ventriculostomy on intracranial pressure (ICP), and related parameters, including cerebrospinal compensation, cerebral oxygenation (PbtO2) and metabolism (microdialysis) in patients with traumatic brain injury (TBI).


METHODS
Twenty-four patients with parenchymal ICP sensors were prospectively included in the study. Ventriculostomy was performed after failure to control ICP with initial measures. Monitoring parameters were digitally recorded before and after ventriculostomy and compared using appropriate tests.


RESULTS
In all patients ventriculostomy led to rapid reduction in ICP. Pooled mean daily values of ICP remained < 20mmHg for 72h after ventriculostomy and were lower than before (p < 0.001). In 11 out of 24 patients during the initial 24-h period following ventriculostomy an increase in ICP to values exceeding 20mmHg was observed. In the remaining 13 patients ICP remained stable, allowing reduction in the intensity of treatment. In this group ventriculostomy led to significant improvement in craniospinal compensation (RAP index), cerebral perfusion pressure and PbtO2. Improvement in lactate/pyruvate ratio, a marker of energy metabolism, was correlated with the increase in PbtO2.


CONCLUSIONS
Ventriculostomy is a useful ICP-lowering manoeuvre, with sustained ICP reduction and related physiological improvements achieved in > 50% of patients.
Timofeev
I
I
Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, P.O. Box 167, Hills Road, Cambridge CB2 0QQ, UK. it227@cam.ac.uk
Dahyot-Fizelier
C
C
Keong
N
N
Nortje
J
J
Al-Rawi
P G
PG
Czosnyka
M
M
Menon
D K
DK
Kirkpatrick
P J
PJ
Gupta
A K
AK
Hutchinson
P J
PJ
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000150:complications*; D002555:Cerebrospinal Fluid / Q000502:physiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology*; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008297:Male; D017551:Microdialysis / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000378:metabolism; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000134:cerebrospinal fluid; D014696:Ventriculostomy / Q000379:methods*
D019344:Lactic Acid; D019289:Pyruvic Acid; D010100:Oxygen