scholarly journals Continuous intracranial pressure monitoring via the shunt reservoir to assess suspected shunt malfunction in adults with hydrocephalus

2007 ◽  
Vol 22 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Romergryko G. Geocadin ◽  
Panayiotis N. Varelas ◽  
Daniele Rigamonti ◽  
Michael A. Williams
Keyword(s):  
Intracranial Pressure ◽  
Medical Therapy ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Symptom Improvement ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Shunt System ◽  
Vp Shunt

Object The authors attempted to determine whether continuous intracrnial pressure monitoring via the shunt resevoir identifies ventriculoperitoneal (VP) shunt malfunctions that are not identified by radionuclide shunt patency study or shunt tap in adults with hydrocephalus. Methods During a 2-year period, 26 adults underwent 32 in-hospital continuous intracranial pressure (ICP) monitoring evaluations via needle access of a shunt reservoir. Monitoring was performed for 26.8 ± 13.8 hours (mean ± standard deviation). No ICP waveform abnormality was detected in 31% of the evaluations (10 of 32). In contrast, abnormalities were detected in 69% (22 of 32 evaluations), including B waves (nine of 22 evaluations), siphoning (nine of 22 evaluations), and variable ICP (two of 22 evaluations). In 20 (91%) of these 22 evaluations, the ICP abnormality was detected only after continuous ICP monitoring; in the other two evaluations, ICP became abnormal immediately on accessing the shunt reservoir. On the basis of the ICP monitoring results, shunt revision was performed in 66% (21 of 32 evaluations) and medical therapy was administered in 34% (11 of 32 evaluations). Shunt revision led to symptom improvement in 82% (18 of 22 patients) and no change in 18% (four of 22 patients); medical therapy led to improvement in 18% (two of 11 patients), worsening in 18% (two of 11 patients), and no change in 64% (seven of 11 patients; p < 0.05). Conclusions Continuous ICP monitoring via the shunt reservoir provides a more accurate assessment of shunt malfunction than transient ICP monitoring with a shunt tap or a radionuclide shunt patency study. It is a safe method for evaluating patients with suspected VP shunt malfunction, provides in vivo assessment of the effect of the shunt system on a patient's ICP, and can lead to more effective shunt revision.

Investigating shunt function using continuous intracranial pressure monitoring in adults: single center experience

2010 ◽  
Vol 113 (6) ◽  
pp. 1326-1330 ◽  
Author(s):  
Ahmed K. Toma ◽  
Andrew Tarnaris ◽  
Neil D. Kitchen ◽  
Laurence D. Watkins
Keyword(s):  
High Pressure ◽  
Intracranial Pressure ◽  
Medical Treatment ◽  
Shunt Malfunction ◽  
Icp Monitoring ◽  
Single Center ◽  
Pressure Monitoring ◽  
Surgical Exploration ◽  
Ventriculoperitoneal Shunts ◽  
Single Center Experience

Object Managing symptomatic ventriculoperitoneal shunts with no clear evidence of shunt malfunction either clinically or radiologically can be a difficult task. The aim of this study was to assess intracranial pressure (ICP) monitoring as a method of investigating shunt function. Methods The authors performed a retrospective analysis of 38 continuous ICP monitoring procedures done in patients with ventriculoperitoneal shunts and suspected shunt malfunction. Results Thirty-eight procedures were performed in 31 patients between January 2005 and October 2008. Sixteen recordings were normal, 6 revealed overdrainage or low pressure, 11 indicated underdrainage or high pressure, and 5 showed variable shunt function. Based on the findings after 20 procedures (53%), patients were treated conservatively: 4 by readjusting the valve setting and 16 by referral to the headache neurologist for medical treatment. Forty-five percent of the conservatively treated patients improved. Surgical exploration was undertaken following 18 procedures (47%); 72% of the surgically treated patients improved. Conclusions Continuous ICP monitoring using an intraparenchymal probe is a safe and effective method of investigating adult hydrocephalus.

Radiographic assessment of snap-shunt failure

2010 ◽  
Vol 6 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Anand I. Rughani ◽  
Bruce I. Tranmer ◽  
Jeffrey E. Florman ◽  
James T. Wilson
Keyword(s):  
Normal Values ◽  
Clinical Symptoms ◽  
Type System ◽  
Shunt Malfunction ◽  
Ct Scans ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Ct Finding

Accurate assessment of imaging studies in patients with ventriculoperitoneal shunts can be aided by empirical findings. The authors characterize an objective measurement easily performed on head CT scans with the goal of producing clear evidence of shunt fracture or disconnection in patients with a snap shunt–type system. The authors describe 2 cases of ventriculoperitoneal shunt failure involving a fracture and a disconnection associated with a snap-shunt assembly. In both cases the initial clinical symptoms were not convincing for shunt malfunction, and the interpretation of the CT finding failed to immediately identify the abnormality. As the clinical picture became more convincing for shunt malfunction, each patient subsequently underwent successful shunt revision. The authors reviewed the CT scans of 10 patients with an intact and functioning snap-shunt system to characterize the normal appearance of the snap-shunt connection. On CT scans the distance between the radiopaque portion of the ventricular catheter and the radiopaque portion of the reservoir dome measures an average of 4.72 mm (range 4.6–4.9 mm, 95% CI 4.63–4.81 mm). In the authors' patient with a fractured ventricular catheter, this interval measured 7.8 mm, and in the patient with a disconnection it measured 7.7 mm. In comparison with the range of normal values, a radiolucent interval significantly greater than 4.9 mm should promptly raise concern for a disconnected or fractured shunt in this system. This measurement may prove particularly useful when serial imaging is not readily available.

Posture-related changes in the pressure environment of the ventriculoperitoneal shunt system

2000 ◽  
Vol 93 (4) ◽  
pp. 614-617 ◽  
Author(s):  
Yoshinaga Kajimoto ◽  
Tomio Ohta ◽  
Hiroji Miyake ◽  
Masanori Matsukawa ◽  
Daiji Ogawa ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Perfusion Pressure ◽  
Upright Position ◽  
Intraabdominal Pressure ◽  
Preventive Effect ◽  
Shunt System ◽  
Content Type ◽  
Vp Shunt ◽  
Programmable Valve ◽  
Fine Print

Object. The purpose of this study is to clarify the whole pressure environment of the ventriculoperitoneal (VP) shunt system in patients with successfully treated hydrocephalus and to determine which factor of the pressure environment has a preventive effect on overdrainage.Methods. Thirteen patients with hydrocephalus who had been treated with VP shunt therapy by using a Codman– Hakim programmable valve without incidence of overdrainage were examined. The authors evaluated intracranial pressure (ICP), intraabdominal pressure (IAP), hydrostatic pressure (HP), and the perfusion pressure (PP) of the shunt system with the patients both supine and sitting.With patients supine, ICP, IAP, and HP were 4.6 ± 3 mm Hg, 5.7 ± 3.3 mm Hg, and 3.3 ± 1 mm Hg, respectively. As a result, the PP was only 2.2 ± 4.9 mm Hg. When the patients sat up, the IAP increased to 14.7 ± 4.8 mm Hg, and ICP decreased to −14.2 ± 4.5 mm Hg. The increased IAP and decreased ICP offset 67% of the HP (42.9 ± 3.5 mm Hg), and consequently the PP (14 ± 6.3 mm Hg) corresponded to only 33% of HP.Conclusions. The results observed in patients indicated that IAP as well as ICP play an important role in VP shunt therapy and that the increased IAP and the decreased ICP in patients placed in the upright position allow them to adapt to the siphoning effect and for overdrainage thereby to be avoided.

Intracranial Pressure Monitoring

1993 ◽  
Vol 4 (1) ◽  
pp. 148-160
Author(s):  
Therese S. Richmond
Keyword(s):  
Critical Care ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Nursing Care ◽  
Critical Care Nurses ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Evaluation Of Care ◽  
Planning Intervention

Intracranial pressure monitoring (ICP) is a technology that assists critical care nurses in the assessment, planning, intervention, and evaluation of care. The physiologic basis of intracranial hypertension (ICH) and ICP monitoring are reviewed. Types of monitors arc described. Advantages, disadvantages, and complications of fluid-filled versus fiberoptic systems are explored. Priorities in nursing care of the patient with an ICP monitor are examined

scholarly journals Study of Intracranial Pressure Monitoring In Traumatic Brain Injury

2018 ◽  
Vol 15 (2) ◽  
pp. 23-29
Author(s):  
Nilam Khadka ◽  
Rajan Kumar Sharma ◽  
Rajiv Jha ◽  
Prakash Bista
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Fiber Optic ◽  
Standard Of Care ◽  
Intracranial Pressure Monitoring ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Serious Adverse Events ◽  
Monitoring Modality

Intracranial pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently. However, the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a trial in which we included 26 patients of all types of traumatic brain injury (TBI) and they were monitored for intracranial pressure by Conventional fluid filled system with a manometer (Group 1) and compared with the Fiber optic transducer-tipped intracranial pressure monitoring system (Group 2).The main aim of this study was to examine the relationship between Intracranial Pressure (ICP) monitoring and in-hospital mortality. The median length of stay in the ICU was similar in the two groups (12 days in the conventional pressure-monitoring group and 9 days in the new fiber optic group; P=0.25), the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was similar in both groups. The distribution of serious adverse events was similar in the two groups. We concluded that ICP monitoring (as is any monitoring modality) is a useful guide for management. The outcomes are decided by the differences in management protocols that the knowledge of the said parameter brings about. ICP monitoring is recommended for the better management of traumatic brain injury and fiber optic ICP monitoring seems to be beneficial than using the conventional methods of ICP monitoring with manometer.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 23-29

Patients Who Benefit from Intracranial Pressure Monitoring without Cerebrospinal Fluid Drainage After Severe Traumatic Brain Injury

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 231-239 ◽  
Author(s):  
Abhijit Lele ◽  
Nithya Kannan ◽  
Monica S Vavilala ◽  
Deepak Sharma ◽  
Mahmud Mossa-Basha ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Intraventricular Hemorrhage ◽  
Cerebrospinal Fluid Drainage ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Severe Tbi

AbstractBACKGROUNDIndia has a high traumatic brain injury (TBI) burden and intracranial pressure monitoring (ICP) remains controversial but some patients may benefit.OBJECTIVETo examine the association between ICP monitor placement and outcomes, and identify Indian patients with severe TBI who benefit from ICP monitoringMETHODSWe conducted a secondary analysis of a prospective cohort study at a level 1 Indian trauma center. Patients over 18 yr with severe TBI (admission Glasgow coma scale score < 8) who received tracheal intubation for at-least 48 h were examined. Propensity-based analysis using inverse probability weighting approach was used to examine ICP monitor placement within 72 h of admission and outcomes. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) score at discharge, 3, 6, and 12 mo. Death, vegetative, or major impairment defined unfavorable outcome.RESULTSThe 200 patients averaged 36 [18 to 85] yr of age and average injury severity score of 31.4 [2 to 73]. ICP monitors were placed in 126 (63%) patients. Patients with ICP monitor placement experienced lower in-hospital mortality (adjusted relative risk [aRR]; 0.50 [0.29, 0.87]) than patients without ICP monitoring. However, there was no benefit at 3, 6, and 12 mo. With ICP monitor placement, absence of cerebral edema (aRR 0.54, 95% confidence interval 0.35-0.84), and absence of intraventricular hemorrhage (aRR 0.52, 95% confidence interval 0.33-0.82) were associated with reduced unfavorable outcomes.CONCLUSIONICP monitor placement without cerebrospinal fluid drainage within 72 h of admission was associated with reduced in-patient mortality. Patients with severe TBI but without cerebral edema and without intraventricular hemorrhage may benefit from ICP monitoring.

scholarly journals Impact of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A K Ali ◽  
A E Abdelbar ◽  
A R Farghaly ◽  
M K A Uthman
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
English Literature ◽  
Intracranial Pressure Monitoring ◽  
Occurrence Rate ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Mortality And Morbidity

Abstract Background Traumatic brain injury (TBI) is among the most important public health problems associated with high healthcare and social burden and significant mortality and morbidity. Overall low income countries have the highest TBI associated mortality and morbidity. Aim of the Work Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality. Patients and Methods Systematic review of Published English literature from 2000 to 2017. Using appropriate combinations of MeSH terms and key words, including intracranial pressure, intracranial hypertension, ICP monitor, intracranial pressure monitoring, TBI traumatic brain injury, and craniocerebral trauma. Brain Trauma Foundation guidelines, mortality. We performed this relatively wide search to include the maximum number of relevant patients. Results In total, 2552 studies were identified and screened for retrieval using the strategy described above. After careening the title and abstract, 1968 studies were excluded and 554 were retrieved and subjected to detailed evaluations. Based on the inclusion and exclusion criteria, 527 of those studies were excluded, and thus 27 studies were included in the systematic review. All included studies were published, peer-previewed papers. Conclusion ICP monitoring may play a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, there was no significant effect for reducing the risk of hospital mortality, lowering occurrence rate of pulmonary infection, use of mechanical ventilation and duration of hospital stays. RCTs with larger sample size are necessary to further support the current results.

scholarly journals Highlighting intracranial pressure monitoring in patients with severe acute brain trauma

1995 ◽  
Vol 53 (3a) ◽  
pp. 390-394 ◽  
Author(s):  
Antonio L. E Falcão ◽  
Venâncio P. Dantas Filho ◽  
Luiz A. C. Sardinha ◽  
Elizabeth M. A. B. Quagliato ◽  
Desanka Dragosavac ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracranial Pressure ◽  
Glasgow Coma Scale ◽  
Brain Trauma ◽  
Intracranial Pressure Monitoring ◽  
Ct Scans ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Focal Lesions ◽  
Coma Scale

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.

The baric probe: a novel long-term implantable intracranial pressure monitor with ultrasound-based interrogation

2012 ◽  
Vol 10 (6) ◽  
pp. 518-524 ◽  
Author(s):  
David D. Limbrick ◽  
Stephen Lake ◽  
Michael Talcott ◽  
Benjamin Alexander ◽  
Samuel Wight ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Linear Relationship ◽  
Ex Vivo ◽  
Shunt Malfunction ◽  
Ultrasound Probe ◽  
In Vivo Models ◽  
Handheld Ultrasound ◽  
Short And Long Term

Object Prompt diagnosis of shunt malfunction is critical in preventing neurological morbidity and death in individuals with hydrocephalus; however, diagnostic methods for this condition remain limited. For several decades, investigators have sought a long-term, implantable intracranial pressure (ICP) monitor to assist in the diagnosis of shunt malfunction, but efforts have been impeded by device complexity, marked measurement drift, and limited instrumentation lifespan. In the current report, the authors introduce an entirely novel, simple, compressible gas design that addresses each of these problems. Methods The device described herein, termed the “baric probe,” consists of a subdural fluid bladder and multichannel indicator that monitors the position of an air-fluid interface (AFI). A handheld ultrasound probe is used to interrogate the baric probe in vivo, permitting noninvasive ICP determination. To assess the function of device prototypes, ex vivo experiments were conducted using a water column, and short- and long-term in vivo experiments were performed using a porcine model with concurrent measurements of ICP via a fiberoptic monitor. Results Following a toe region of approximately 2 cm H2O, the baric probe's AFI demonstrated a predictable linear relationship to ICP in both ex vivo and in vivo models. After a 2-week implantation of the device, this linear relationship remained robust and reproducible. Further, changes in ICP were observed with the baric probe, on average, 3 seconds in advance of the fiberoptic ICP monitor reading. Conclusions The authors demonstrate “proof-of-concept” and feasibility for the baric probe, a long-term implantable ICP monitor designed to facilitate the prompt and accurate diagnosis of shunt malfunction. The baric probe showed a consistent linear relationship between ICP and the device's AFI in ex vivo and short- and long-term in vivo models. With a low per-unit cost, a reduced need for radiography or CT, and an indicator that can be read with a handheld ultrasound probe that interfaces with any smart phone, the baric probe promises to simplify the care of patients with shunt-treated hydrocephalus throughout both the developed and the developing world.

scholarly journals Intracranial Pressure Monitoring in Severe Traumatic Brain Injury – Results of a Canadian Survey

2000 ◽  
Vol 27 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Ramesh Sahjpaul ◽  
Murray Girotti
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Prospective Trial ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Level Of Confidence ◽  
Routine Monitoring ◽  
Severe Tbi ◽  
High Level

ABSTRACT:Objective:The purpose of this study was to obtain information from Canadian neurosurgeons regarding their opinions on, and utilization of, intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI).Methods:A brief survey was sent to practicing Canadian neurosurgeons questioning them about their utilization of, and confidence in, intracranial pressure monitoring in the management of patients with severe TBI.Results:One hundred and ninety-six surveys were mailed. There were 103 responses for a response rate of 52.6%. The vast majority of responding neurosurgeons (98.1%) utilized ICP monitoring in the management of patients with severe TBI, with most (63.4%) using it in more than 75% of their patients, 14.9% using it in 50-75% of patients, 14.9% in 25-50% of patients, and 6.9% using it in less than 25% of patients. The level of confidence that routine monitoring improves outcome from severe TBI ranged from 23.3% having a low level of confidence, 56.3% having an intermediate level of confidence, to 20.4% having a high level of confidence. Most respondents (78.6%) felt that some form of prospective trial evaluating the role of ICP monitoring in improving outcome from severe TBI was warranted; 17.4% felt such a trial was not warranted and 3.9% were uncertain.Conclusions:While ICP monitoring has gained almost universal acceptance among responding Canadian neurosurgeons, their level of confidence that routine monitoring improves outcome from severe TBI was quite variable, with only 20.4% of respondents having a high level of confidence. Over 75% of respondents felt that some form of prospective trial evaluating the utility of ICP monitoring is warranted. This information is being used in consideration of a prospective trial addressing this issue.

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