Intraparenchymal Fiber-Optic Intracranial Pressure Monitoring

Patients with neurological pathologies either have or are at risk for an increase in intracranial pressure. These patients benefit from close and invasive neurological monitoring. One proven way to directly monitor for increased intracranial pressure is by insertion of a fiber-optic pressure monitor directly into the brain parenchyma. Intracranial monitoring was first used over half a century ago to monitor for and to guide the treatment of intracranial hypertension. More recently, fiber-optic pressure monitors have become the most commonly used version of that tool. With few absolute contraindications, they can be placed in patients with a variety of neurologic insults that are known to cause increased intracranial pressure. Pathologies such as anoxic brain injury and traumatic brain injury and patients at risk for further neurologic decline while heavily sedated or paralyzed have all benefited from this type of invasive neurological monitoring. Placement can be done by properly trained advanced practice providers, at the bedside, safely and efficiently. By utilizing advanced practice providers, the resource burden on already minimal neurosurgical teams in the acute care setting can be decreased. This chapter will describe, in detail, the procedure, the indications, the contraindications, and the rationale for the procedure of the placement of a fiber-optic intracranial pressure monitor.