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Updated: Aug 6, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Implantation Standards for Intracranial Multimodal Monitoring (Neurocore-iMMM): An International Delphi Consensus
Sami Barrit1,2,3, Trinity Pate4, Maria A Poca5
1Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 90095, USA. sami.barrit@ucsf.edu.
Background/Objective:
Intracranial multimodal monitoring (iMMM) use is expanding, yet inconsistent documentation of the implantation procedure prevents data comparability and accurate safety profiling. We aimed to establish implantation standards defining which variables require documentation and at what specificity.
Methods:
We conducted a three-round modified Delphi (May-August 2025) with an international panel of 82 experts with hands-on implantation experience. We investigated items common to the foundational Neurocore-iMMM consensus to test agreement between panels. Thresholds: ≥ 75% strong agreement, 66-74% moderate, and < 50% no consensus.
Results:
Retention was 72% through all rounds. Of 120 items (47% participant-proposed), 57 achieved consensus. Agreed-upon standards include probe placement documentation specifying tissue type (perilesional or normal-appearing), approach (image-guided or standardized), and post-placement imaging verification (99%); complication reporting specifying misplacement (98%), postoperative hemorrhage with location (99%), and CNS infection with colonization distinguished from infection by CSF cell count and mandatory culture of withdrawn material (95%); adverse event subcategorization of accuracy drift into probe displacement, calibration loss, and signal instability (91%); and documentation of leveling reference for fluid-filled lines (78%), fixation device configuration (77%), and recalibration protocol (76%). On 25 of 29 items shared with the foundational consensus, the two independent panels reached concordant agreement.
Conclusions:
Aligned with NIH Common Data Elements, these implantation standards specify documentation from anatomical targeting designation to adverse event subcategorization for cross-center comparison, providing the item-level foundation from which reporting criteria can be operationalized and an implementation-ready framework for multicenter neurocritical care databases and monitoring-guided therapy trials.
