Simultaneous measurements of intracranial pressure parameters in the epidural space and in brain parenchyma in patients with hydrocephalus

Clinical article

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Object

In this study, the authors compare simultaneous measurements of static and pulsatile pressure parameters in the epidural space and brain parenchyma of hydrocephalic patients.

Methods

Simultaneous intracranial pressure (ICP) signals from the epidural space (ICPEPI) and the brain parenchyma (ICPPAR) were compared in 12 patients undergoing continuous ICP monitoring as part of their diagnostic workup for hydrocephalus. The static ICP was characterized by mean ICP and the frequency of B waves quantified in the time domain, while the pulsatile ICP was determined from the cardiac beat–induced single ICP waves and expressed by the ICP pulse pressure amplitude (dP) and latency (dT; that is, rise time).

Results

The 12 patients underwent a median of 22.5 hours (range 5.9–24.8 hours) of ICP monitoring. Considering the total recording period of each patient, the mean ICP (static ICP) differed between the 2 compartments by ≥ 5 mm Hg in 8 patients (67%) and by ≥ 10 mm Hg in 4 patients (33%). In contrast, for every patient the ICP pulse pressure readings from the 2 compartments showed near-identical results. Consequently, when sorting patients to shunt/no shunt treatment according to pulsatile ICP values, selection was independent of sensor placement. The frequency of B waves also compared well between the 2 compartments.

Conclusions

The pulsatile ICP is measured with equal confidence from the ICPEPI and ICPPAR signals. When using the pulsatile ICP for evaluation of hydrocephalic patients, valid measurements may thus be obtained from pressure monitoring in the epidural space. Recorded differences in the mean ICP between the epidural space and the brain parenchyma are best explained by differences in the zero setting of different sensors.

Abbreviations used in this paper: ICP = intracranial pressure; ICPEPI = ICP in the epidural space; ICPPAR = ICP in the brain parenchyma; iNPH = idiopathic normal pressure hydrocephalus.

Article Information

Address correspondence to: Per Kristian Eide, M.D., Ph.D., Department of Neurosurgery, Oslo University Hospital–Rikshospitalet, 0027 Oslo, Norway. email: per.kristian.eide@rikshospitalet.no.

Please include this information when citing this paper: published online August 27, 2010; DOI: 10.3171/2010.7.JNS10483.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    A 10-minute trend plot of the mean ICP (static ICP), calculated every subsequent 6-second time window, for the epidural space (A) and the brain parenchyma (B) sensors. The detection routine identifies peaks and valleys in the trend plot, and all increases in mean ICP (dICP) ≥ 10, ≥ 15, and ≥ 20 mm Hg are identified. The profile of each trend plot of the mean ICP could be quantified (C).

  • View in gallery

    The raw signal of the epidural space (A) and the brain parenchyma ICP signal (B) showing the cardiac beat–induced waves from which the pulsatile ICP is determined. For every cardiac-induced wave, the following pulsatile ICP parameters are determined: amplitude, rise time, and rise time coefficient (C). The time window shown in panels A and B lasts 6 seconds, which is the time window for determining the mean ICP wave amplitude, rise time, and rise time coefficient.

  • View in gallery

    The distribution of differences (Diff) in single pressure wave amplitude (dP) between the 2 compartments (ICPPAR − ICPEPI) is shown in all patients. The following data are presented as the mean ± SD with the number of single waves (SWs) in parentheses. A: Case 1, −0.13 ± 0.55 mm Hg (15,816). B: Case 2, −0.09 ± 0.20 mm Hg (98,269). C: Case 3, −0.09 ± 0.74 mm Hg (31,474). D: Case 4, −0.03 ± 0.25 mm Hg (61,492). E: Case 5, −0.04 ± 0.46 mm Hg (39,129). F: Case 6, −0.31 ± 0.28 mm Hg (63,509). G: Case 7, 0.23 ± 0.27 mm Hg (116,920). H: Case 8, −0.22 ± 0.42 mm Hg (85,497). I: Case 9, −0.36 ± 0.23 mm Hg (54,216). J: Case 10, 0.004 ± 0.16 mm Hg (102,233). K: Case 11, −0.05 ± 0.22 mm Hg (46,413). L: Case 12, −0.07 ± 0.27 mm Hg (43,606).

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