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Dural sinus pressure: various aspects in human brain surgery in children and adults
Insights
Dural sinus pressure (confluens sinuum pressure, CSP) varies significantly with patient age and body positioning during neurosurgery. Children generally exhibit higher CSP than adults, with specific positions like neck anteflexion impacting pressure differently across age groups.
Area of Science:
- Neurosurgery
- Physiology
- Vascular Pressure Monitoring
Background:
- Air embolism and venous hemorrhage are critical risks in neurosurgery.
- Accurate measurement of dural sinus pressure (confluens sinuum pressure, CSP) is vital for patient safety.
Purpose of the Study:
- To investigate dural sinus pressure (CSP) under diverse physiological and surgical conditions.
- To compare CSP measurements between adults and children, and across different pressure transducer types.
Main Methods:
- Measured CSP in 47 cases (11 children) using extracranial or catheter transducers.
- Assessed CSP variations with surgical positions, body inclination, neck movements, and jugular compression.
- Compared pressure readings between two transducer types and age groups.
Main Results:
- Catheter transducers yielded ~30% higher CSP values than extracranial ones.
- Children consistently showed higher CSP than adults, especially in the sitting position.
- Body elevation decreased CSP linearly; neck anteflexion significantly lowered it in adults.
- Neck rotation increased CSP in children; jugular compression effectively elevated CSP to prevent air embolism.
Conclusions:
- Patient age and body positioning are crucial determinants of CSP.
- Findings challenge the notion that positive-pressure respiration elevates CSP.
- Understanding CSP dynamics is essential for neurosurgical safety and physiological insights.
Abstract:
To prevent air embolism and minimize neurosurgical venous hemorrhage, the dural sinus pressure (confluens sinuum pressure, CSP) was examined under various conditions in 47 cases, 11 of whom were children. Either the extracranial (group A) or catheter type (group B) pressure transducer was used. The latter gave approximately 30% higher values than the former. In any surgical position, children showed a tendency toward higher pressure than did adults. This was particularly the case in the sitting position; adults showed negative pressure [-8.6 +/- 2.3 (SD) mmHg, group A], whereas all eight children less than 9 yr of age (group A, 5 cases; group B, 3 cases) showed positive pressure. The youngest with negative CSP in a sitting position was a 9-yr-old boy. When the upper half of the body was raised, the CSP decreased linearly and became zero at approximately 25 degrees. In anteflexion of the neck, the CSP decreased significantly, and even with inclination of the upper half of the body of only 15-20 degrees or more upward, negative pressure was observed in adults. In children, right and left rotation of the neck showed remarkable increase of the CSP. In both supine and sitting positions, CSP was elevated sufficiently by bilateral jugular compression to prevent air embolism. Positive-pressure respiration did not raise the CSP, contrary to widely accepted knowledge. This study was originally performed in relation to brain surgery, but the results also seemed to be valuable in physiology.