Cerebral microdialysis is increasingly used to monitor several types of neurocritical patients. This study presents the technique used in our unit for percutaneous implantation of cerebral microdialysis
catheters using a small twist-drill craniostomy that can be performed in the intensive care unit (ICU). We also present the results of this technique in 89 head-injured patients and in eight patients with a malignant middle cerebral artery (
MCA) infarction. One hundred and twenty-two cerebral microdialysis
catheters were implanted in the 97 patients included in this study. One cerebral microdialysis
catheter was implanted in the less damaged hemisphere of 67 head-injured patients with a
diffuse brain injury. An additional microdialysis
catheter was inserted in the pericontusional parenchyma of 22 patients with
brain contusions. In five of the eight patients with a malignant
MCA infarction, only one microdialysis probe was inserted in the penumbral zone. In the remaining three patients, two cerebral microdialysis
catheters were implanted in the same hemisphere (one in the ischemic core and the other in the penumbra). Technical problems were detected in 18 (15%) of the 122 microdialysis
catheters implanted and were more frequent during the initial period of using microdialysis in our unit. In four patients (3% of implanted
catheters), follow-up computed tomography (CT) scans showed a small intracerebral blood collection (always <or=1 cc) around the microdialysis
catheter. There were no microdialysis-related
infections. In conclusion, percutaneous insertion of single or multiple microdialysis
catheters in neurocritical patients by using twist drill craniostomy is feasible, fast, and safe.