Placing a Subdural Bolt | Licox

• The forehead on the non dominant side of the head  is shaved. Clean the area thoroughly. A mark is made 10 cm posterior from nasion along the midline and 3 cm to right of the midline. The area was then prepped and draped with standard aseptic technique ( whole body drape is applied) . The area of planned entry is  anesthetized with lidocaine  with epinephrine. Be liberal is the use of Lodocaine with epinephrine since the purpose is to both numb the area and prevent bleeding. A linear incision was made roughly 2-cm over the target burr hole entry point. Identify and ligate all bleeders with cautery.  The incision is now retracted open with a Weitlander.

• Make sure you have a clear view of the cranium. Attach the appropriate drill bit that comes with the Licox kit, to the hand-held drill. The cranium is trepanated with a 0.25” burr hole using the hand-held drill. The direction of approach of the drill is towards the imagined centre of the brain. The depth of the drill bit is increased about 1 to 2 mm at a time. Expect to reach the dura at about 1.3 to 1.5 cm.  Attention is made to ensure the drill does not penetrate the dura. The dura is opened with  a cruciate incision made on the dura using a surgical  blade. The bolt is secured using a twisting clockwise  motion, half a turn at a time.

• The triple lumen catheters are passed through the metal bolt till it fits snugly . Now the cap is screwed on to secure the triple lumen in place.

• The Camino ICP monitor is calibrated ex vivo to zero reference, then inserted into the ICP port, and secured. The Licox Temperature probe and brain tissue O2 probe are then inserted into their appropriate ports. The skin incision is secured with  interrupted 3-0 nylon sutures. Now the Temperature and Oxygen probe can be attached to the Licox monitor. Allow a few hours for the in vivo calibration of all the sensors.

My little blog entry only runs through the procedure of cranial bolt and probe placement. Be prudent to carefuly go through all indications, contraindications and possible complications associated. The procedure is not incredibily difficult and is possibly something all Neurointensivists should learn  to perform.

Good Luck.

Below is a link showing the Licox Catheter System by Integra Neuroscience System, NJ

http://ccn.aacnjournals.org/content/23/4/17/F1.expansion.html