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Best zero level for external ICP transducer.

Peter Reinstrup1, Mårten Unnerbäck2, Niklas Marklund3

  • 1Department of Intensive & Perioperative care, Skanes University Hospital, Lund, Sweden. Peter.Reinstrup@med.lu.se.

Acta Neurochirurgica
|March 9, 2019
PubMed
Summary
This summary is machine-generated.

Accurate intracranial pressure (ICP) monitoring requires precise zero-referencing. External auditory meatus (EAM) and glabella are ideal references for brain center (BC) ICP when the head is supine or lateral, with corrections for head elevation.

Keywords:
ICPIntracranial pressureMonitoringZero reference point

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Physiology

Background:

  • Continuous intracranial pressure (ICP) monitoring is crucial for neurological assessment.
  • Accurate ICP readings depend on correct zero-referencing to anatomical landmarks.
  • Previous methods lacked standardized reference points across different head positions.

Purpose of the Study:

  • To evaluate various anatomical landmarks as zero-reference points for ICP monitoring.
  • To assess the accuracy of ICP measurements at different head positions relative to brain center (BC), foramen of Monro (Monro), and brain surface.
  • To determine optimal zero-reference points for reliable ICP monitoring.

Main Methods:

  • Utilized 3D MRI scans from patients with normal neurological exams.
  • Identified and projected key anatomical landmarks: Monro, BC, Orbit (O), external auditory meatus (EAM), and orbito-meatal (OM) line.
  • Measured distances from skin to brain surface, BC, and Monro across supine, 45° head elevation, upright, and 45° lateral positions.

Main Results:

  • External auditory meatus (EAM) or glabella served as ideal references for BC-ICP in supine and lateral positions.
  • Head elevation (45°) and upright positions resulted in overestimations of BC-ICP (4.8 ± 0.8 and 5.6 ± 0.5 mmHg, respectively).
  • A 45° lateral position underestimated BC-ICP by 6.3 ± 1.0 mmHg. Corrective additions of 5.9-6.3 mmHg improved accuracy.

Conclusions:

  • EAM and glabella are reliable references for BC-ICP in supine/lateral positions, but clinical variations exist.
  • The orbito-meatal (OM) line tracks Monro during head elevation but not lateral rotation.
  • Using the highest external head point underestimates ICP; applying a constant correction factor yields the most accurate readings.