title: A novel single twist-drill access device for multimodal intracranial monitoring: a 5-year single-institution experience.
abstract: BACKGROUND
  Multimodal intracranial monitoring in the neurosurgical patient requires insertion of probes through multiple craniostomies.
  
  
  OBJECTIVE
  To report our 5-year experience with a novel device allowing multimodal monitoring though a single twist-drill hole.
  
  
  METHODS
  All devices (Hummingbird Synergy, Innerspace) were placed at the Kocher point between 2008 and 2013 at our institution. An independent clinical research nurse prospectively collected data on all bedside placements. Placement accuracy was graded on computed tomography scan as grade 1 (ipsilateral frontal horn or third ventricle), grade 2 (contralateral lateral ventricle), and grade 3 (anywhere else). Infection was monitored with serial cerebrospinal fluid samples.
  
  
  RESULTS
  Two hundred seventy-five devices (198 at bedside, 77 in operating room) were placed in patients with spontaneous subarachnoid hemorrhage (49%), traumatic brain injury (47%), and others (4%) for a median duration of 6 days. A junior (postgraduate year 1-2), midlevel (postgraduate year 3-4), or senior resident (postgraduate year 5-6) placed 39%, 32%, and 29% of the devices, respectively. Ninety-two percent of all devices placed were draining cerebrospinal fluid, ie, were grade 1 (75%) or 2 (17%). Placement accuracy did not vary with level of training. Complications included hemorrhage (10%) and infection (4%), with 1 patient requiring intraparenchymal hematoma evacuation and a second requiring abscess drainage. These rates were lower than reported in the literature for standard external ventricular drains.
  
  
  CONCLUSIONS
  Hummingbird Synergy is a novel single-port access device for multimodal intracranial monitoring that can be placed safely at the bedside or in the operating room with placement accuracy and has a complication profile similar to or better than that for standard external ventricular drains.
authors.affiliation: *Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico; ‡Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Muhammad Omar
authors.initials: MO
authors.lastname: Chohan
authors.forename: Omar S
authors.initials: OS
authors.lastname: Akbik
authors.forename: Juan
authors.initials: J
authors.lastname: Ramos-Canseco
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Ramirez
authors.forename: Cristina
authors.initials: C
authors.lastname: Murray-Krezan
authors.forename: Tracey
authors.initials: T
authors.lastname: Berlin
authors.forename: Kim
authors.initials: K
authors.lastname: Olin
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Taylor
authors.forename: Howard
authors.initials: H
authors.lastname: Yonas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects* / Q000295:instrumentation*; D055815:Young Adult