Erroneous Measurement of Intracranial Pressure Caused by Simultaneous Ventricular Drainage: A Hydrodynamic Model Study

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 348-354 ◽  
Author(s):  
Harold A. Wilkinson ◽  
Jorge Yarzebski ◽  
Edward C. Wilkinson ◽  
Frederick A. Anderson
Keyword(s):  
Intracranial Pressure ◽  
High Pressures ◽  
Ventricular Catheter ◽  
Csf Flow ◽  
Pressure Setting ◽  
Clinical Observations ◽  
Csf Drainage ◽  
Model Study ◽  
Csf Production ◽  
Brain Pressure

Abstract Intracranial pressure (ICP) is often measured from intraventricular catheters, a technique that allows therapeutic drainage of ventricular cerebrospinal fluid (CSF) as an aid in controlling ICP and circumventing obstruction. Drainage of CSF simultaneously with ongoing ICP measurement has been advocated as safe and efficient, and devices are commercially available to permit this practice; however, this concept has been seriously challenged, based on clinical observations. The inaccuracy induced by simultaneous CSF drainage and ICP monitoring is quantitated in this report in a mechanical brain model using a standard ventricular catheter. The following conclusions have been confirmed: 1) rapid CSF drainage induces a severe artifactual reduction in measured ICP, more extreme at higher pressures; 2) calibrated slower rates of CSF drainage produce a severe, although less immediate, reduction in measured ICP; 3) severe artifact appears even in the presence of continuous CSF outflow, so a system that measures ICP only in the presence of CSF flow does not prevent artifact; 4) with simultaneous CSF drainage, measured ICP is determined more by the outflow pressure setting than by actual brain pressure; 5) Since ICP elevation of 25 to 30 mm Hg blocks CSF production, even slow fluid drainage at high pressures should ultimately lead to ventricular collapse and severe artifact.

scholarly journals Third ventriculostomy through the lamina terminalis for intracranial pressure monitoring after aneurysm surgery: technical note

2002 ◽  
Vol 60 (4) ◽  
pp. 932-934 ◽  
Author(s):  
Jorge L. Kraemer ◽  
Pedro L. Gobbato ◽  
Yuri M. Andrade-Souza
Keyword(s):  
Intracranial Pressure ◽  
Drainage System ◽  
Technical Note ◽  
Acute Stage ◽  
Third Ventriculostomy ◽  
Ventricular Catheter ◽  
Lamina Terminalis ◽  
Aneurysm Surgery ◽  
External Drainage ◽  
Csf Drainage

OBJECTIVE: A new ventriculostomy technique through the lamina terminalis is described. This technique is applied mainly during aneurysm surgery at the acute stage. METHOD: Thirteen patients were operated on intracranial aneurysms and, during the procedure, had the lamina terminalis fenestrated. A ventricular catheter was inserted into the third ventricule, left in place and connected to an external drainage system for further intracranial pressure (ICP) monitoring and/or cerebrospinal fluid (CSF) drainage. RESULTS: ICP readings and CSF drainage were obtained in all cases. No complication was recorded. CONCLUSION: Third ventriculostomy through the lamina terminalis is a simple and easy technique that can be used as an alternative to conventional ventriculostomy. This procedure can be indicated in cases where the ventricule is not reached by means of another technique, and when the decision to perform ventriculostomy is made at the end of aneurysm surgery.

A clinical comparison of subdural screw pressure measurements with ventricular pressure

1983 ◽  
Vol 58 (1) ◽  
pp. 45-50 ◽  
Author(s):  
A. David Mendelow ◽  
John O. Rowan ◽  
Lilian Murray ◽  
Audrey E. Kerr
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Fluid Pressure ◽  
Ventricular Catheter ◽  
Pressure Measurements ◽  
Content Type ◽  
Single Lumen ◽  
Ventricular Fluid Pressure ◽  
Fine Print

✓ Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

In vitro experiment for verification of the tandem shunt valve system: a novel method for treating hydrocephalus by flexibly controlling cerebrospinal fluid flow and intracranial pressure

2013 ◽  
Vol 11 (1) ◽  
pp. 43-47
Author(s):  
Yasuo Aihara ◽  
Ichiro Shoji ◽  
Yoshikazu Okada
Keyword(s):  
Intracranial Pressure ◽  
Flow Rate ◽  
Csf Shunt ◽  
Main Function ◽  
Csf Flow ◽  
Shunt Valve ◽  
Cerebrospinal Fluid Flow ◽  
Valve System ◽  
Programmable Valve

Object The CSF shunt valve is a medical device whose main function is to regulate intracranial pressure and drain excess CSF. The authors have developed a new therapeutic method for treating hydrocephalus, namely the tandem shunt valve system, which has the potential of flexibly controlling the CSF flow rate and intracranial pressure in patients. Methods The properties of the tandem system were verified by performing in vitro experiments. An in vitro system with a manometer was built to measure pressure and flow rates of water in open systems using the Codman Hakim Programmable Valve and the Strata adjustable pressure programmable valve. A single valve and 2 single shunt valves connected in series (the tandem shunt valve system) were connected to the manometer to check the final pressure. Results Conventional single shunt valve systems require valve pressures to be set higher to slow down the CSF flow rate, which inevitably results in a higher final pressure. On the other hand, the tandem shunt valve system uses the combination of 2 valves to slow the CSF flow rate without increasing the final pressure. Conclusions The authors succeeded in experimentally demonstrating in vitro results of tandem systems and their effectiveness by applying a model to show that the valve with the higher pressure setting determined the final pressure of the entire system and the flow rate became slower than single shunt valve systems.

Slit Ventricle Syndrome Presenting with Paroxysmal Hypersomnia in an Adult: Case Report

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 594-595 ◽  
Author(s):  
Ender Korfali ◽  
Kaya Aksoy ◽  
Imran Safi
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Shunt Malfunction ◽  
Ventricular Catheter ◽  
Ventricular Enlargement ◽  
Adult Case ◽  
Slit Ventricle Syndrome ◽  
Computed Tomographic ◽  
Lateral Ventricles ◽  
Slit Ventricle

Abstract The slit ventricle syndrome (SVS), defined as intermittent shunt malfunction without substantial ventricular enlargement, is usually observed in shunted children with small, slitlike ventricles. This syndrome has been attributed to recurrent obstruction of the ventricular catheter, which then causes an increase of intracranial pressure. Only rarely has the SVS been reported in adults. We describe a 29-year-old woman whose shunt malfunction presented with longlasting paroxysmal hypersomnia and was diagnosed with computed tomographic evidence of small lateral ventricles. This episodic hypersomnia presented every 2 to 3 weeks and each episode lasted 1 to 2 weeks. After revision of the ventricular catheter, her symptoms stopped and she remained well. (Neurosurgery 22:594-595, 1988)

Management of proximal shunt obstruction

1988 ◽  
Vol 68 (5) ◽  
pp. 817-819 ◽  
Author(s):  
Charles C. Duncan
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Intracranial Pressure ◽  
Signs And Symptoms ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Obstruction ◽  
Fine Print

✓ Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients with such obstruction by cannulation of the reservoir and ventricular catheter to penetrate into the ventricle with a 3½-in. No. 22 spinal needle. The findings in 20 cases in which this approach was utilized are summarized.

Dose response to cerebrospinal fluid drainage on cerebral perfusion in traumatic brain–injured adults

2001 ◽  
Vol 11 (4) ◽  
pp. 1-7 ◽  
Author(s):  
Mary E. Kerr ◽  
Barbara B. Weber ◽  
Susan M. Sereika ◽  
Jack Wilberger ◽  
Donald W. Marion
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Cerebral Blood Flow Velocity ◽  
Cerebrospinal Fluid Drainage ◽  
Dose Time ◽  
Physiological Variables ◽  
Time Interaction ◽  
Csf Drainage ◽  
Significant Difference

Object Intracranial hypertension remains a common complication of traumatic brain injury (TBI). Ventriculostomy drainage is a recommended therapy to decrease intracranial pressure (ICP), but little empirical evidence exists to guide treatment. The authors conducted a study to examine systematically the effect of cerebral spinal fluid (CSF) drainage on ICP and indices of cerebral perfusion. Methods Intracranial pressure, cerebral perfusion pressure (CPP), cerebral blood flow velocity (CBFV), and near-infrared spectroscopy–determined regional cerebral oxygenation (rSO2) were measured in 58 patients (with Glasgow Coma Scale scores ≤ 8) before, during, and after ventriculostomy drainage. Three randomly ordered CSF drainage protocols varied in the volume of CSF removed (1 ml, 2 ml, and 3 ml). Physiological variables were time averaged in 1-minute blocks from baseline to 10 minutes after cessation of ventricular drainage. There was a significant dose–time interaction for ICP with the three-extraction volume protocol, with incremental decreases in ICP (F [20, 1055] = 6.10; p = 0.0001). There was a significant difference in the CPP depending on the amount of CSF removed (F [2, 1787] = 3.22; p = 0.040) and across time (F [10, 9.58] = 11.9; p = 0.0003) without a significant dose–time interaction. A 3-ml withdrawal of CSF resulted in a 10.1% decrease in ICP and a 2.2% increase in CPP, which were sustained for 10 minutes. There was no significant dose, time or dose–time interaction with CBFV or rSO2. Conclusions Cerebrospinal fluid drainage (3 ml) significantly reduced ICP and increased CPP for at least 10 minutes. Analysis of these findings supports the use of ventriculostomy drainage as a means of at least temporarily reducing elevated ICP in patients with TBI.

scholarly journals Volume of cerebrospinal fluid drainage as a predictor for pretreatment aneurysmal rebleeding

2018 ◽  
Vol 128 (6) ◽  
pp. 1778-1784 ◽  
Author(s):  
Jasper H. van Lieshout ◽  
Ina Pumplün ◽  
Igor Fischer ◽  
Marcel A. Kamp ◽  
Jan F. Cornelius ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Treatment Protocol ◽  
Definitive Treatment ◽  
Ventricular Catheter ◽  
Acute Management ◽  
Clinical Predictors ◽  
Csf Drainage ◽  
Highly Correlated

OBJECTIVEInitiation of external CSF drainage has been associated with a significant increase in rebleeding probability after aneurysmal subarachnoid hemorrhage (aSAH). However, the implications for acute management are uncertain. The purpose of this study was to evaluate the role of the amount of drained CSF on aneurysmal rebleeding.METHODSConsecutive patients with aSAH were analyzed retrospectively. Radiologically confirmed cases of aneurysmal in-hospital rebleeding were identified and predictor variables for rebleeding were retrieved from hospital records. Clinical predictors were identified through multivariate analysis, and logistic regression analysis was performed to ascertain the cutoff value for the rebleeding probability.RESULTSThe study included 194 patients. Eighteen cases (9.3%) of in-hospital rebleeding could be identified. Using multivariate analysis, in-hospital rebleeding was significantly associated with initiation of CSF drainage (p = 0.001) and CSF drainage volume (63 ml [interquartile range (IQR) 55–69 ml] vs 25 ml [IQR 10–35 ml], p < 0.001). Logistic regression showed that 58 ml of CSF drainage within 6 hours results in a 50% rebleeding probability. The relative risk (RR) for rebleeding after drainage of more than 60 ml in 6 hours was 5.4 times greater compared with patients with less CSF drainage (RR 5.403, 95% CI 2.481–11.767; p < 0.001, number needed to harm = 1.687).CONCLUSIONSVolume of CSF drainage was highly correlated with the probability of in-hospital aneurysmal rebleeding. These findings suggest that the rebleeding probability can be affected in acute management should the placement of an external ventricular catheter be necessary. This finding necessitates meticulous control of the amount of drained CSF and the development of a definitive treatment protocol for this group of patients.

Telemetric ICP monitoring after surgery for posterior fossa and third ventricular tumors

1984 ◽  
Vol 60 (3) ◽  
pp. 649-651 ◽  
Author(s):  
Paul H. Chapman ◽  
Eric Cosman ◽  
Michael Arnold
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Content Type ◽  
Clinical Observations ◽  
Ventricular Tumors ◽  
Fine Print

✓ After surgery for posterior fossa or third ventricular tumors, hydrocephalus may persist or evolve. Proper management of this complication requires timely detection. Temporary external ventricular drainage has been suggested by some authors as an adjunct to clinical observations and radiographic studies for unshunted patients. As an alternative, the authors have used a telemetric method of pressure monitoring in association with a ventricular catheter and subcutaneous reservoir. This has been found useful in eight patients without the disadvantages inherent in other methods of management.

scholarly journals Cerebrospinal fluid formation is controlled by membrane transporters to modulate intracranial pressure

2021 ◽  
Author(s):  
Eva K. Oernbo ◽  
Annette B. Steffensen ◽  
Pooya Razzaghi Khamesi ◽  
Trine L. Toft-Bertelsen ◽  
Dagne Barbuskaite ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Choroid Plexus ◽  
Molecular Mechanisms ◽  
Osmotic Gradient ◽  
Pharmaceutical Therapy ◽  
Osmotic Water ◽  
Life Threatening ◽  
Molecular Mode ◽  
Csf Production

AbstractDisturbances in the brain fluid balance can lead to life-threatening elevation in the intracranial pressure (ICP), which represents a vast clinical challenge. Nevertheless, the molecular mechanisms governing cerebrospinal fluid (CSF) secretion are largely unresolved, thus preventing targeted and efficient pharmaceutical therapy of cerebral pathologies involving elevated ICP. Here, we employed experimental rats to demonstrate low osmotic water permeability of the choroid plexus, lack of an osmotic gradient across this tissue, and robust CSF secretion against osmotic gradients. Together, these results illustrate that CSF secretion occurs independently of conventional osmosis, which challenges the existing assumption that CSF production is driven entirely by bulk osmotic forces across the CSF-secreting choroid plexus. Instead, we reveal that the choroidal Na+/K+/Cl− cotransporter NKCC1, Na+/HCO3− cotransporter NBCe2, and Na+/K+-ATPase are actively involved in CSF production and propose a molecular mode of water transport supporting CSF production in this secretory tissue. Further, we demonstrate that inhibition of NKCC1 directly reduces the ICP, illustrating that altered CSF secretion may be employed as a strategy to modulate ICP. These insights identify new promising therapeutic targets against brain pathologies associated with elevated ICP.

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