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How is ICP monitored?
Ventriculostomy is the most common method of meas-uring ICP. A catheter is placed through a burr hole and into the anterior horn of a lateral ventricle.
Obliteration of the ventricle due to tumor or edema may create technical difficulties inserting the catheter. Subdural bolts also serve to measure ICP. These devices are placed via a twist drill hole in the calvarium and a small hole in the dura. They are less invasive than a ventriculostomy and provide only local pressure data instead of global information. Subdural bolts can become infected and lack the potential to withdraw CSF for lowering ICP. Proper positioning requires the bolt’s head to be aligned in the same plane as underlying brain. Catheters or electronic transducers placed in the epidural space can also be used for ICP monitoring. Lumbar subarachnoid catheters are occasionally used. The accuracy of these devices is impaired by patient positioning other than horizontal. Abrupt withdrawal of CSF through lum-bar subarachnoid catheters risks brain herniation.
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