Can we safely monitor posterior fossa intracranial pressure? A cadaveric study

Abstract

Background: measuring intracranial pressure (ICP) is considered the gold standard of care for brain injury. While supratentorial ICP monitoring has been adopted everywhere, posterior fossa ICP monitoring is rarely performed. In this study, we aimed to evaluate the feasibility of inserting ICP sensors into the posterior fossa of cadavers, to measure ICP in the posterior fossa.

Methods: An ICP sensor was transcranially implanted into the posterior fossa of fifteen fresh adult cadavers. An extracranial point was defined in the retroauricular area 2 cm behind the tip of the mastoid process and 2 cm below the transverse sinus, in order to implant an ICP probe. The cranial cavity was opened and measures were taken of the distance that the ICP sensor had penetrated inside the posterior fossa, as well as the distance to nearby venous sinuses (lateral, transverse, sigmoid, inferior petrosal sinus, and jugular bulb). The cerebellar hemisphere was searched for any possible damage.

Results: the selected extracranial point (2 cm behind the tip of the mastoid process and 2 cm below the transverse sinus) was a safe location. Intracranial structures such as the brainstem and the cerebellar hemisphere were not damaged. The implanted ICP probe was at least 2 cm away from the venous sinuses, which were not damaged.

Conclusion: ICP monitoring is safe and reliable at the described ICP probe placement site of the posterior fossa.

Keywords:

• Intracranial pressure monitoring
• Posterior fossa
• Posterior fossa tumour
• Cerebellar hematoma
• Brain injury

Acknowledgements

To the Department of Human Anatomy and Embryology of the Faculty of Medicine of the Valencia University, particularly to the laboratory curators Lucia and Carmina and to Dr. Tomás Hernández Gil de Tejada and to all personnel of the Instituto de Medicina Legal de Valencia for its assistance in this study.

Disclosure statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; education grants, participation inn speakers’ bureaus; membership, employment, consultancies, stock ownership, or other entity interest; and expert testimony or patent licensing arrangements), or non-financial interests (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

This article was performed on human cadavers.

Additional information

Funding

No funding has been received for this research.