Hemorrhagic complications of intracranial pressure monitors in children

Pediatr Neurosurg. 2003 Jul;39(1):27-31. doi: 10.1159/000070877.


Intracranial pressure (ICP) monitoring plays a valuable role in the management of head injuries and other causes of raised ICP in the pediatric population. The purpose of this study was to investigate the incidence of hemorrhage after ICP monitor insertion, and to classify these complications in a clinically relevant manner. Hospital charts of 431 children (ages 0-16 years) admitted to a level I trauma center over a 2-year period were reviewed and 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring were identified. The authors reviewed postoperative neuroradiological studies. One hundred and nineteen procedures were carried out without any hemorrhage (grade 0). After 10 insertions, a small punctate hemorrhage or localized subarachnoid hemorrhage occurred (grade 1). Three patients sustained an intracerebral hemorrhage that did not require evacuation or manifest as a new neurological deficit (grade 2). There were no hemorrhagic complications that necessitated evacuation or resulted in a noticeable change in the patient's clinical condition (grade 3). We propose a new grading system for hemorrhage after ICP monitor insertion. We found a complication rate close to 10% in our pediatric patients. Fortunately, these hemorrhages were clinically silent and no neurosurgical intervention was necessary. However, grade 1 and grade 2 hemorrhages may manifest with a false reading of high ICP, and the long-term consequences of these complications are not known. Of note, only 23% of these complications were reflected in the patients charts, which may explain the low complication rates reported in other studies that did not analyze postoperative neuroradiological studies.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Brain Diseases / complications*
  • Brain Diseases / diagnostic imaging*
  • Brain Diseases / physiopathology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Hydrocephalus / diagnostic imaging*
  • Hydrocephalus / etiology*
  • Hydrocephalus / physiopathology
  • Infant
  • Intracranial Hemorrhages / diagnostic imaging*
  • Intracranial Hemorrhages / etiology*
  • Intracranial Hemorrhages / physiopathology
  • Intracranial Hypertension / diagnostic imaging*
  • Intracranial Hypertension / etiology*
  • Intracranial Hypertension / physiopathology
  • Male
  • Monitoring, Physiologic / adverse effects*
  • Neurosurgical Procedures / adverse effects*
  • Postoperative Complications*
  • Retrospective Studies
  • Tomography, X-Ray Computed