A Critical Evaluation of Continuous Intracranial Pressure Monitoring in Pediatric Hydrocephalus

Abstract

An evaluation of continuous intracranial pressure (ICP) monitoring in 42 hydrocephalic infants and children helps to establish the role of this method in comparison with other clinical techniques for estimating the occurrence of progressive hydrocephalus. Transducer monitoring via ventricular catheters in term and premature infants revealed average ICP in the 5–12 mm Hg range. The higher values were recorded from patients with noncommunicating hydrocephalus but did not correlate with the extent of ventriculomegaly. The method has very little predictive value in estimating the progressive nature of infantile hydrocephalus. In older children ICP monitoring provides a useful adjunct in decisions for shunting after intracranial surgery and in suspected ‘normal pressure’ hydrocephalus. Monitoring from shunt reservoirs in cases of suspected shunt obstruction, although accurate in most situations, is probably inferior to clinical examination and serial computed tomography considering the expense and the risk of introducing shunt sepsis.

Transcranial optical monitoring for detecting intracranial pressure alterations in children with benign external hydrocephalus: a proof-of-concept study

“…16 The presence of B-waves is indicative of reduced intracranial compliance, and they appear mainly during the rapid eye movement (REM) sleep when there is an increase in cerebral blood flow (CBF) and brain metabolism. [18][19][20][21] The alteration of cerebral autoregulation or reactivity due to reduced intracranial compliance could be pathological in such a scenario.…”

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

“…23 Following an evidentiary analysis and a review of the 98 full-text articles, 68 publications were accepted for inclusion in the evidentiary table and 30 publications were excluded. 2,7,[12][13][14]21,22,27,30,33,35,38,48,[50][51][52][53]55,57,58,[62][63][64][66][67][68]70,73,75 The evidentiary table was assembled linking recommendations to the strength of the evidence (Levels I-III).…”

Is normal pressure hydrocephalus a valid concept in 2002? A reappraisal in five questions and proposal for a new designation of the syndrome as "chronic hydrocephalus"

“…It is generally agreed that there is a relation between ICP and the age of children, with ICP values progressively increasing from subatmospheric levels in the neonate to a range of 20-70 mm H 2 O during infancy and ultimately to its adult levels by the age of eight years. [46][47][48] Several studies reported in the literature have shown that a condition comparable with NPH may not be uncommon in childhood. [49][50][51][52][53][54][55][56] From a clinical standpoint, a paediatric form of the triad may be characterised as follows: v Subtle mental deterioration manifested by poor or decreasing scholar performances; v Anomalies of gait manifested either by walking retardation in infants or by repeated falling spells in older children; v Anomalies of micturition with delayed bladder control, whose relation to hydrocephalus is frequently overlooked or ascribed to enuresis.…”