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The relationship between basal cisterns on CT and time-linked intracranial pressure in paediatric head injury

Alison J Kouvarellis1, Ursula K Rohlwink, Vishesh Sood

  • 1Division of Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|May 4, 2011
PubMed

Insights

Open basal cisterns in pediatric severe traumatic brain injury (TBI) do not rule out elevated intracranial pressure (ICP). This finding suggests that open cisterns on CT scans should not deter ICP monitoring in these patients.

Area of Science:

  • Pediatric neurosurgery
  • Neurocritical care
  • Neuroradiology

Background:

  • Intracranial pressure (ICP) monitoring is crucial for managing severe traumatic brain injury (TBI) in children.
  • Decisions regarding ICP monitoring often rely on head CT scan findings, particularly basal cistern patency.
  • The significance of open basal cisterns in relation to ICP levels in pediatric TBI remains unclear.

Observation:

  • This study analyzed ICP data from 104 pediatric severe TBI patients.
  • Basal cisterns were classified as open, effaced, or obliterated on head CT scans.
  • ICP values were assessed in relation to CT scan timing.

Findings:

  • Over 40% of scans with open basal cisterns showed episodes of ICP ≥ 20 mmHg.
  • 14% of scans with open cisterns had a mean ICP ≥ 20 mmHg.
  • The specificity of open cisterns for predicting ICP < 20 mmHg was poor (57.9%), with worse outcomes in younger children.

Implications:

  • Open basal cisterns on CT scans in children with severe TBI do not exclude the possibility of elevated ICP.
  • ICP monitoring should not be withheld solely based on the presence of open basal cisterns.
  • These findings may refine clinical decision-making for ICP monitoring in pediatric TBI management.
Abstract

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