Simultaneous measurements of intracranial pressure parameters in the epidural space and in brain parenchyma in patients with hydrocephalus

2010 ◽  
Vol 113 (6) ◽  
pp. 1317-1325 ◽  
Author(s):  
Per Kristian Eide ◽  
Wilhelm Sorteberg
Keyword(s):  
Intracranial Pressure ◽  
Epidural Space ◽  
Pulse Pressure ◽  
Brain Parenchyma ◽  
Pressure Amplitude ◽  
Icp Monitoring ◽  
Simultaneous Measurements ◽  
Pulsatile Pressure ◽  
The Mean ◽  
The Brain

Object In this study, the authors compare simultaneous measurements of static and pulsatile pressure parameters in the epidural space and brain parenchyma of hydrocephalic patients. Methods Simultaneous intracranial pressure (ICP) signals from the epidural space (ICPEPI) and the brain parenchyma (ICPPAR) were compared in 12 patients undergoing continuous ICP monitoring as part of their diagnostic workup for hydrocephalus. The static ICP was characterized by mean ICP and the frequency of B waves quantified in the time domain, while the pulsatile ICP was determined from the cardiac beat–induced single ICP waves and expressed by the ICP pulse pressure amplitude (dP) and latency (dT; that is, rise time). Results The 12 patients underwent a median of 22.5 hours (range 5.9–24.8 hours) of ICP monitoring. Considering the total recording period of each patient, the mean ICP (static ICP) differed between the 2 compartments by ≥ 5 mm Hg in 8 patients (67%) and by ≥ 10 mm Hg in 4 patients (33%). In contrast, for every patient the ICP pulse pressure readings from the 2 compartments showed near-identical results. Consequently, when sorting patients to shunt/no shunt treatment according to pulsatile ICP values, selection was independent of sensor placement. The frequency of B waves also compared well between the 2 compartments. Conclusions The pulsatile ICP is measured with equal confidence from the ICPEPI and ICPPAR signals. When using the pulsatile ICP for evaluation of hydrocephalic patients, valid measurements may thus be obtained from pressure monitoring in the epidural space. Recorded differences in the mean ICP between the epidural space and the brain parenchyma are best explained by differences in the zero setting of different sensors.

PVDF Sensor: Design and Development for Use as Intracranial Pressure Monitoring Device

2009 ◽  
Author(s):  
V. Vijaywargi ◽  
R. Proffitt ◽  
P. Mane ◽  
K. Mossi ◽  
K. Ward ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intracranial Pressure ◽  
Applied Pressure ◽  
Monitoring Device ◽  
Risk Of Infection ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
High Frequencies ◽  
Novel Method ◽  
The Brain

The brain is surrounded by cerebrospinal fluid, and when a brain tumor or a traumatic brain injury has occurred, intracranial pressure, ICP, is developed. Monitoring ICP non-invasively is a challenge. Currently, a probe is inserted through the skull, running the risk of infection, bleeding, and damage to the brain tissue with residual neurologic effects. A novel method to measure ICP using actuators and sensors has been proposed where the skull is vibrated at high frequencies and the receiving signal is measured at the surface eyelid. A design of experiments approach is used to develop the sensor part of the ICP monitoring device so that gain can be maximized using factors such as area, thickness, electrode, and applied pressure. In addition, sensor packaging is optimized to minimize dampening of the signal and ensure durability, reliability, and repeatability of the measurements. Results of this study showed that for a range of areas and thicknesses with Cu-Ni electrodes packaged with super strength durable tape are the optimum factors for the ICP sensor. These parameters are then incorporated into a design that allows ease of application and consistency of the measurements.

Medical Management of Elevated Intracranial Pressure

Neurotrauma ◽  
2019 ◽  
pp. 1-8
Author(s):  
Courtney Pendleton ◽  
Jack Jallo
Keyword(s):  
Intracranial Pressure ◽  
Medical Management ◽  
Elevated Intracranial Pressure ◽  
Icp Monitoring ◽  
Head Ct ◽  
Multiple Strategies ◽  
Brain Trauma Foundation ◽  
Abnormal Head ◽  
Patient Families ◽  
The Brain

Elevated intracranial pressure (ICP) may be a sequelae of head trauma, as well as cerebral infarcts and spontaneous intracranial hemorrhages. It is a commonly seen conundrum in neurosurgical practice. Management of elevated ICP is guided by etiology, patient factors, and guidelines for medical and operative treatment. The Brain Trauma Foundation guidelines recommend ICP monitoring in patients with a Glasgow Coma Scale score of less than 8 and an abnormal head CT, or in patients with a normal head CT who meet other inclusion criteria. Once ICP monitoring is begun, multiple strategies for maintaining a goal below 20 are recognized and may be added in a stepwise fashion and continued concurrently. Failure of medical therapy to control ICP may require operative intervention. At the time of initial consultation and throughout medical management of ICP, frank discussions with patient families is essential to accurately communicate prognosis and set expectations for clinical outcomes.

Longitudinal diffusion-weighted imaging in infants with hydrocephalus: decrease in tissue water diffusion after cerebrospinal fluid diversion

2009 ◽  
Vol 4 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Paul H. Leliefeld ◽  
Rob H. J. M. Gooskens ◽  
Kees P. J. Braun ◽  
Lino M. P. Ramos ◽  
Cuno S. P. M. Uiterwaal ◽  
...  
Keyword(s):  
Brain Parenchyma ◽  
Periventricular White Matter ◽  
Normal Range ◽  
Arterial Blood ◽  
Diffusion Weighted ◽  
Age Related ◽  
Adc Values ◽  
Csf Diversion ◽  
The Mean ◽  
The Brain

Object Progressive hydrocephalus may lead to edema of the periventricular white matter and to damage of the brain parenchyma because of compression, stretching, and ischemia. The aim of the present study was to investigate whether cerebral edema can be quantified using diffusion-weighted imaging in infants with hydrocephalus and whether CSF diversion could decrease cerebral edema. Methods Diffusion-weighted MR imaging was performed in 24 infants with progressive hydrocephalus before and after CSF diversion. Parametric images of the trace apparent diffusion coefficients (ADCs) were obtained. The ADCs of 5 different cortical and subcortical regions of interest were calculated pre- and postoperatively in each patient. The ADC values were compared with age-related normal values. Mean arterial blood pressure and anterior fontanel pressure were measured immediately after each MR imaging study. Results After CSF diversion, the mean ADC decreased from a preoperative value of 1209 ± 116 × 10−6 mm2/second to a postoperative value of 928 ± 64 × 10−6 mm2/second (p < 0.005). Differences between pre- and postoperative ADC values were most prominent in the periventricular white matter, supporting the existence of preoperative periventricular edema. Compared with age-related normal values, the preoperative ADC values were higher and the postoperative ADC values were lower, although within normal range. The decrease in ADC after CSF drainage was more rapid than the more gradual physiological decrease that is related to age. The preoperative ICP was elevated in all patients. After CSF diversion the ICP decreased significantly to within the normal range. A linear correlation between ADC values and ICP was found (correlation coefficient 0.496, p < 0.001). In all patients the mean arterial blood pressure was within physiological limits both pre- and postoperatively. Conclusions This study shows a rapid and more extensive decrease in ADC values after CSF diversion than is to be expected from physiological ADC decrease solely due to increasing patient age. The preoperative ADC increase can be explained by interstitial edema caused by transependymal CSF leakage or by vasogenic edema caused by capillary compression and stretching of the brain parenchyma. This study population of infants with (early recognized) hydrocephalus did not suffer from cytotoxic edema. These findings may help to detect patients at risk for cerebral damage by differentiating between progressive and compensated hydrocephalus.

A new expandable cannula system for endoscopic evacuation of intraparenchymal hemorrhages

2009 ◽  
Vol 111 (6) ◽  
pp. 1127-1130 ◽  
Author(s):  
Vicknes Waran ◽  
Narayanan Vairavan ◽  
Sheau Fung Sia ◽  
Basri Abdullah
Keyword(s):  
Intracranial Pressure ◽  
Endoscopic Surgery ◽  
Ct Scanning ◽  
Brain Parenchyma ◽  
Intracranial Pressure Monitoring ◽  
Pressure Monitoring ◽  
Endoscopic Evacuation ◽  
Microsurgical Techniques ◽  
The Brain

The authors describe a newly developed expandable cannula to enable a more efficient use of an endoscope in removing intraparenchymal spontaneous hypertensive intracerebral hematomas. The cannula is introduced like a conventional brain cannula, using neuronavigation techniques to reach the targeted hematoma accurately, and, once deployed, conventional microsurgical techniques are used under direct endoscopic visualization. This method was used in 6 patients, and, based on the results of intraoperative intracranial pressure monitoring and postoperative CT scanning, the authors were able to achieve good hematoma removal. They found that by using the expandable cannula, efficient endoscopic surgery in the brain parenchyma was possible.

scholarly journals Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

2015 ◽  
Vol 122 (1) ◽  
pp. 202-210 ◽  
Author(s):  
Halinder S. Mangat ◽  
Ya-Lin Chiu ◽  
Linda M. Gerber ◽  
Marjan Alimi ◽  
Jamshid Ghajar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Mortality Rate ◽  
Hypertonic Saline ◽  
New York State ◽  
Mortality Rates ◽  
Icp Monitoring ◽  
Severe Tbi ◽  
The Mean

OBJECT Increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) is associated with a higher mortality rate and poor outcome. Mannitol and hypertonic saline (HTS) have both been used to treat high ICP, but it is unclear which one is more effective. Here, the authors compare the effect of mannitol versus HTS on lowering the cumulative and daily ICP burdens after severe TBI. METHODS The Brain Trauma Foundation TBI-trac New York State database was used for this retrospective study. Patients with severe TBI and intracranial hypertension who received only 1 type of hyperosmotic agent, mannitol or HTS, were included. Patients in the 2 groups were individually matched for Glasgow Coma Scale score (GCS), pupillary reactivity, craniotomy, occurrence of hypotension on Day 1, and the day of ICP monitor insertion. Patients with missing or erroneous data were excluded. Cumulative and daily ICP burdens were used as primary outcome measures. The cumulative ICP burden was defined as the total number of days with an ICP of > 25 mm Hg, expressed as a percentage of the total number of days of ICP monitoring. The daily ICP burden was calculated as the mean daily duration of an ICP of > 25 mm Hg, expressed as the number of hours per day. The numbers of intensive care unit (ICU) days, numbers of days with ICP monitoring, and 2-week mortality rates were also compared between the groups. A 2-sample t-test or chi-square test was used to compare independent samples. The Wilcoxon signed-rank or Cochran-Mantel-Haenszel test was used for comparing matched samples. RESULTS A total of 35 patients who received only HTS and 477 who received only mannitol after severe TBI were identified. Eight patients in the HTS group were excluded because of erroneous or missing data, and 2 other patients did not have matches in the mannitol group. The remaining 25 patients were matched 1:1. Twenty-four patients received 3% HTS, and 1 received 23.4% HTS as bolus therapy. All 25 patients in the mannitol group received 20% mannitol. The mean cumulative ICP burden (15.52% [HTS] vs 36.5% [mannitol]; p = 0.003) and the mean (± SD) daily ICP burden (0.3 ± 0.6 hours/day [HTS] vs 1.3 ± 1.3 hours/day [mannitol]; p = 0.001) were significantly lower in the HTS group. The mean (± SD) number of ICU days was significantly lower in the HTS group than in the mannitol group (8.5 ± 2.1 vs 9.8 ± 0.6, respectively; p = 0.004), whereas there was no difference in the numbers of days of ICP monitoring (p = 0.09). There were no significant differences between the cumulative median doses of HTS and mannitol (p = 0.19). The 2-week mortality rate was lower in the HTS group, but the difference was not statistically significant (p = 0.56). CONCLUSIONS HTS given as bolus therapy was more effective than mannitol in lowering the cumulative and daily ICP burdens after severe TBI. Patients in the HTS group had significantly lower number of ICU days. The 2-week mortality rates were not statistically different between the 2 groups.

Catecholamine response to a gradual increase of intracranial pressure

1993 ◽  
Vol 79 (5) ◽  
pp. 705-709 ◽  
Author(s):  
Johan van Loon ◽  
Bharati Shivalkar ◽  
Chris Plets ◽  
Jan Goffin ◽  
T. Budya Tjandra-Maga ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Perfusion Pressure ◽  
Gradual Increase ◽  
Hemodynamic Changes ◽  
Content Type ◽  
Catecholamine Response ◽  
Cushing Response ◽  
The Mean ◽  
The Brain

✓ To determine the catecholamine response to progressive intracranial hypertension, intracranial pressure (ICP) was raised gradually by continuous expansion of an epidural balloon in seven dogs. Hemodynamic parameters, ICP, and cerebral perfusion pressure (CPP) were monitored continuously and serum catecholamine levels began to rise when CPP was in the low-positive range (20 to 30 mm Hg), reaching a peak just after brain death (CPP ≤ 0 mm Hg). There was no correlation between ICP and the catecholamine peak. Compared to control values, the mean increase was 286-fold for epinephrine and 78-fold for norepinephrine. Temporally, the catecholamine peak corresponded well with the observed hemodynamic changes. These results suggest that ischemia in certain parts of the brain stem is responsible for the hemodynamic changes observed in intracranial hypertension (such as the Cushing response), and they show that catecholamines play an important role in these hemodynamic changes.

scholarly journals Intraoperative Measurement of Intracranial Pressure During Cranial Vault Remodeling in Children with Craniosynostosis

2022 ◽  
Author(s):  
Sonia Bansal ◽  
Subhas Konar ◽  
Dhaval Shukla ◽  
Dwarakanath Srinivas ◽  
Vishram Pandey ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intraoperative Monitoring ◽  
External Ventricular Drainage ◽  
Cranial Vault ◽  
Icp Monitoring ◽  
Height Reduction ◽  
Csf Diversion ◽  
The Mean ◽  
Entire Procedure ◽  
Cranial Vault Remodeling

Abstract Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The ICP recordings helped in undoing the height reduction in two children and ventriculoperitoneal shunt after surgery in two children. Conclusions Intraoperative monitoring of ICP helps in deciding the type of cranial vault remodeling and the need for CSF diversion after surgery.

scholarly journals Assessing changes in cervical epidural pressure during biportal endoscopic lumbar discectomy

2020 ◽  
pp. 1-7
Author(s):  
Taewook Kang ◽  
Si Young Park ◽  
Soon Hyuck Lee ◽  
Jong Hoon Park ◽  
Seung Woo Suh
Keyword(s):  
Intracranial Pressure ◽  
Epidural Space ◽  
Irrigation System ◽  
Phase 1 ◽  
Lumbar Discectomy ◽  
Phase 2 ◽  
Epidural Pressure ◽  
Working Space ◽  
The Mean ◽  
Endoscopic Lumbar Discectomy

OBJECTIVEBiportal endoscopic spinal surgery has been performed for several years, and its effectiveness is well known; however, no studies on its safety, specifically intracranial pressure, have been conducted to date. The authors sought to evaluate the effect of biportal endoscopic lumbar discectomy on intracranial pressure by monitoring cervical epidural pressure (CEP) changes throughout the procedure.METHODSTwenty patients undergoing single-level biportal endoscopic lumbar discectomy were enrolled in this study. CEPs were monitored throughout the procedure, consisting of phase 1, establishing the surgical portal and working space; phase 2, performing decompression and discectomy; and phase 3, turning off the fluid irrigation system. After discectomy was completed, the authors evaluated changes in CEP as the irrigation pressure increased serially by adding phase 4, increasing irrigation pressure with outflow open; and phase 5, increasing irrigation pressure with outflow closed.RESULTSThe mean baseline CEP was measured as 16.65 mm Hg. In phase 1, the mean CEP was 17.3 mm Hg, which was not significantly different from the baseline CEP. In phase 2, the mean CEP abruptly increased up to 35.1 mm Hg when the epidural space was first connected with the working space, followed by stabilization of the CEP at 31.65 mm Hg. In phase 4, the CEP increased as the inflow pressure increased, showing a linear correlation, but not in phase 5. No patients experienced neurological complications.CONCLUSIONSIt is important to ensure that irrigation fluid is not stagnant and is maintained continuously. More attention must be paid to keeping pressures low when opening the epidural space.

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