One Hole in the Skull Enables Multiple Types of Monitoring for People With Brain Injuries
Study shows that several tracking instruments fed through one skull aperture safely provide crucial information about brain states after trauma.
In the United States, traumatic brain injuries send 1.7 million people to emergency rooms every year and kill 52,000, according to the Centers for Disease Control and Prevention. These injuries can lead to swelling, loss of consciousness, paralysis, erratic behavior and other problems. Men suffer traumatic brain injuries twice as often as women do.
Measuring intracranial pressure has been the standard way of monitoring brain-injured hospital patients, but by itself it provides limited information on the patient’s condition. Effective treatment is further hindered by imprecise definitions of traumatic brain injury and lack of real-time data.
To insert the pressure-sensing instrument, doctors create an access hole in the skull -- a modern version of an ancient procedure once known as "trepanning," which has been used for everything from epilepsy to supposed demon possession. In a new study from a team at the University of Cincinnati Medical Center, researchers assessed the safety of inserting additional instruments through the same hole to gain more information about a patient's condition.
The study included 43 patients (36 men and seven women) whose brain injuries resulted in loss of consciousness. In each patient the researchers drilled a 5.3-centimeter cranial aperture to insert five probes that measured intracranial pressure, temperature, oxygen level, cerebral blood flow and electrical activity. The patients wore the devices for two to four days while the researchers tracked how well the monitoring devices worked.
The primary problem encountered was occasional disconnection of the devices during patient transport. There were no serious complications from the drilling or insertion procedures.
Knowing the full range of parameters “provides an opportunity to guide management in a more precise, patient-specific way,” the authors wrote. Now that they have demonstrated the safety of multimodality monitoring, the researchers recommend further research to determine whether it improves clinical outcomes. Their report appeared June 8 in the journal Neurocritical Care.