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A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
Published on: October 17, 2017
Characteristics of intracranial pressure (ICP) waves and ICP in children with treatment-responsive hydrocephalus
Terje Sæhle1, Per Kristian Eide
1Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, PB 4950 Nydalen, 0424, Oslo, Norway.
Insights
Pediatric hydrocephalus patients who improved after surgery showed higher intracranial pressure (ICP) wave amplitudes and mean ICP. These findings suggest improved intracranial compliance is key to shunt effectiveness in children.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Engineering
Background:
- Pediatric hydrocephalus treatment aims to normalize intracranial pressure (ICP) and optimize brain development.
- Understanding ICP wave characteristics in hydrocephalus offers insights into treatment mechanisms.
Purpose of the Study:
- To characterize ICP waves in pediatric hydrocephalus patients who improved after surgery.
- To compare ICP characteristics between surgically treated and non-surgically managed hydrocephalus patients.
Main Methods:
- Retrospective analysis of ICP monitoring data from 2002-2011 in pediatric hydrocephalus patients.
- Determination of ICP wave amplitude, rise time, rise time coefficient, and mean ICP.
- Comparison of ICP parameters between surgically treated and reference (non-surgically managed) groups.
Main Results:
- 58 patients included; 31 underwent surgery and showed clinical improvement.
- Surgically treated patients exhibited increased mean ICP and elevated ICP wave amplitudes (MWA) compared to reference patients.
- ICP alterations were similar in communicating and non-communicating hydrocephalus, with no correlation to symptoms, ventricular size, or age.
Conclusions:
- Clinically improved pediatric hydrocephalus patients present with elevated MWA and mean ICP.
- Elevated MWA suggests impaired intracranial compliance, a state reversible by shunting.
- Improved intracranial compliance is a likely mechanism for shunt efficacy in pediatric hydrocephalus.
Background:
One important goal of modern treatment of pediatric hydrocephalus is to normalize the intracranial pressure (ICP) and ICP volume reserve capacity to optimize normal brain development. Better knowledge of the characteristics of ICP waves/ICP in pediatric hydrocephalus may provide new insight into the mechanisms behind modern hydrocephalus treatment. The aim of the present work was to characterize the ICP waves/ICP in children with either communicating or non-communicating hydrocephalus who improved clinically after surgery. The hydrocephalic children not treated surgically following ICP monitoring served as reference patients.
Methods:
The patient material includes all children with hydrocephalus and no previous surgical treatment who underwent diagnostic ICP wave/ICP monitoring during the period 2002-2011. We retrieved the information about the patients from the patient records and the digitally stored ICP waveforms. The ICP wave characteristics amplitude, rise time and rise time coefficient and the mean ICP were determined in the patients treated surgically for their hydrocephalus. The findings were compared with findings in children not treated surgically after ICP monitoring who served as reference patients.
Results:
The patient material includes 58 patients. Thirty-one (53%) were treated surgically after ICP monitoring, of whom all improved clinically. As compared to the reference patients, patients treated surgically presented with increased ICP wave amplitudes (MWA) and mean ICP. Alterations were comparable in communicating and non-communicating hydrocephalus. We found no apparent association between the ICP wave/ICP scores and presence of symptoms, indices of ventricular size or age.
Conclusions:
Children with either communicating or non-communicating hydrocephalus improving clinically after surgery presented with elevated MWA and mean ICP. In particular, the levels of MWA were raised to a magnitude seen when intracranial compliance is impaired. Hence, the present observations may support the idea that improvement of intracranial compliance can be an important mechanism by which shunts work in pediatric hydrocephalus.
