Limitations and Complications Connected with Monitoring of Subdural Intracranial Pressure and Insertion of Jugular Catheter

  • Niels Juul
  • Georg E. Cold


With any invasive monitoring procedure the risk of adverse events is present. The incidence of dural tears during opening of the surgical field has previously been reported in the literature. Predisposing factors for accidental dural tears occurring during supratentorial craniotomy have been reported. Predisposing factors included extracerebral pathology (meningioma), age of the patients, thickness of the cranial vault, the presence of hyperostosis frontalis and a frontal or pterional location. In elderly patients adhesions between the dura and the skull are increased, leaving dura more vulnerable during craniotomy. Moreover, with respect to the auxiliary surgical tools, the use of the drill was associated significantly with dural tears. In this chapter the adverse effects of subdural monitoring are disclosed. In addition the potential dangers of jugular venous puncture and wound infection are discussed.


Surgical Site Infection Antibiotic Prophylaxis Cranial Vault Dural Tear Jugular Catheter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Barker FG (1994) Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis. Neurosurgery 35:484–490PubMedCrossRefGoogle Scholar
  2. Blomstedt GC (1985) Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurchir 78:81–90CrossRefGoogle Scholar
  3. Cajozzo M, Quintini G, Cocchiera G et al (2004) Comparison of central venous catheterization with and without ultrasound guide. Transfus Apher Sci 31:199–202CrossRefPubMedGoogle Scholar
  4. Clenaghan S, McLaughlin RE, Martyn C et al (2006) Relationship between Trendelenburg tilt and internal jugular vein diameter. Emerg Med J 23:661Google Scholar
  5. Engelhardt M, Uhlenbruch S. Christmann A et al (2005) Accidental dural tears occurring during supratentorial craniotomy. A prospective analysis of predisposing factors in 100 patients. Zentralbl Neurochir 66:70–74CrossRefGoogle Scholar
  6. Erman T, Demirhindi H, Göcer AI et al (2005) Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Surg Neurol 63:107–113CrossRefPubMedGoogle Scholar
  7. Gaillard T, Gilsbach JM (1991) Intra-operative antibiotic prophylaxis in neurosurgery. A prospective, randomised, controlled study on cefotiam. Acta Neurochir 113:103–109CrossRefGoogle Scholar
  8. George R, Leibrock L, Epstein M (1979) Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience. J Neurosurg 51:804–811PubMedCrossRefGoogle Scholar
  9. Hayashi H, Amano M (2002) Does ultrasound imaging before puncture facilitate internal jugular vein cannulation? Prospective randomized comparison with landmark-guided puncture in ventilated patients. J Cardiothorac Vasc Anesth 16:572–575CrossRefPubMedGoogle Scholar
  10. Idali B, Lahyat B, Khaleq K et al (2004) Postoperative infection following craniotomy in adults. J Med Mal 34:221–224CrossRefGoogle Scholar
  11. Korinek A-M, Golmard J-L, Elcheick A et al (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4578 patients. Br J Neurosurg 19:155–162CrossRefPubMedGoogle Scholar
  12. Kourbeti IS, Jacobs AV, Koslow M (2007) Risk factors associated with postcraniotomy meningitis. Neurosurgery 60:317–326CrossRefPubMedGoogle Scholar
  13. Schummer W, Schummer C, Rose N et al (2007) Mechanical complications and malpositions of central venous cannulation by experienced operators: a prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med 33:1055–1059CrossRefPubMedGoogle Scholar
  14. Sheridan RL, Weber JM (2006) Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters. J Burn Care Res 27:13–18Google Scholar
  15. Sulek CA, Gravenstein N, Blackshear RH et al (1996) Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg 82:125–128CrossRefPubMedGoogle Scholar
  16. Tenney JH, Vlahov D, Salcman M et al (1985) Wide variation in risk of wound infection following clan neurosurgery. Implications for perioperative antibiotic prophylaxis. J Neurosurg 62:243–247PubMedCrossRefGoogle Scholar
  17. Zhang J, Ling-Yi C, Meng B et al (2007) Meningioma without dural attachment: case report, classification, and review of the literature. Surg Neurol 67:535–539CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  • Niels Juul
    • 1
  • Georg E. Cold
    • 2
  1. 1.Department of NeuroanaesthesiaAarhus University HospitalAarhus CDenmark
  2. 2.Aarhus VDenmark

Personalised recommendations