Intraparenchymal intracranial pressure monitoring for hydrocephalus and cerebrospinal fluid disorders

Abstract

BackgroundElective intraparenchymal intracranial pressure (ICP) monitoring is useful for the diagnosis and treatment of hydrocephalus and cerebrospinal fluid (CSF) disorders. This retrospective study analyzes median ICP and pulse amplitude (PA) recordings in neurosurgically naïve patients undergoing elective ICP monitoring for suspected CSF disorders.MethodsRetrospective review of prospectively collated database of neurosurgically naïve patients undergoing elective ICP monitoring for suspected hydrocephalus and CSF disorders. Following extraction of the median ICP and PA values (separated into all, day and night time recordings), principal component analysis (PCA) was performed to identify the principal factors determining the spread of the data. Exploratory comparisons and correlations of ICP and PA values were explored, including by post hoc diagnostic groupings and age.ResultsA total of 198 patients were identified in six distinct diagnostic groups (n = 21–47 in each).The PCA suggested that there were two main factors accounting for the spread in the data, with 61.4% of the variance determined largely by the PA and 33.0% by the ICP recordings.Exploratory comparisons of PA and ICP between the diagnostic groups showed significant differences between the groups. Specifically, significant differences were observed in PA between a group managed conservatively and the Chiari/syrinx, IIH, and NPH/LOVA groups and in the ICP between the conservatively managed group and high-pressure, IIH, and low-pressure groups. Correlations between ICP and PA revealed some interesting trends in the different diagnostic groups and correlations between ICP, PA, and age revealed a decreasing ICP and increasing PA with age.ConclusionsThis study provides insights into hydrodynamic disturbances in different diagnostic groups of patients with CSF hydrodynamic disorders. It highlights the utility of analyzing both median PA and ICP recordings, stratified into day and night time recordings.

Monitoring and Measurement of Intracranial Pressure in Pediatric Head Trauma

“…This is in obvious disagreement with the generally accepted perception that ICP is lower in children than in adults. However, the same age-related ICP pattern was shown in a mixed diagnostic cohort from age 16 to 85 years (56). Studies examining the lumbar puncture opening pressure (CSF op ) specify a diagnostic cut-off at 25-28 cm H 2 O (18-21 mmHg) (57,58).…”

“…In summary, the lack of consistence in age of childhood and the differing contribution of extracranial injuries, challenges the threshold-comparison and emphasizes the need for greater consistency in pediatric research. The currently used treatment threshold is considerably higher than ICP reference values proposed in studies examining "normal" ICP (52,55,56,76,77), which could be one of the reasons for the still ambiguous benefit of ICP monitoring and regulation in pediatric patients with severe TBI.…”

Cerebral Vascular Changes During Acute Intracranial Pressure Drop

“…Measurement of intracranial pressure (ICP) is used to guide targeted therapy of acute brain injury during a patient's stay in a neurological intensive care unit (NICU) [1][2][3][4][5][6]. External ventricular drain (EVD) remains the gold standard for both monitoring ICP and diverting cerebrospinal fluid (CSF) from the ventricles in clinical situations requiring the management of acute hydrocephalus or temporary CSF drainage [7][8][9].…”

Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study

“…Elevated ICP is associated with mortality and poor clinical outcome in traumatic brain injury patients (TBI), subarachnoid hemorrhage patients (SAH), and others [6][7][8][9]. Therefore, the ability to continuously monitor ICP, analyze ICP waveform, and derive cerebral indices is pivotal in understanding pathology, targeting therapy, and predicting prognosis [10][11][12]. The technique most commonly used in clinical practice to monitor ICP involves external ventricular drain (EVD) and intraparenchymal pressure monitor, while the latter only allows ICP monitoring without a combined therapeutic option of cerebrospinal fluid (CSF) drainage [13].…”