Chronic monitoring of intracranial pressure using an in vivo calibrating sensor: experience in patients with pseudotumor cerebri

Telemetric Intracranial Pressure Monitoring: A Systematic Review

Telemetric intracranial pressure (ICP) monitoring is a new method of measuring ICP which eliminates some of the shortcomings of previous methods. However, there are limited data on specific characteristics, including the advantages and disadvantages of this method. The main aim of this study was to demonstrate the indications, benefits, and complications of telemetric ICP monitoring. PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for relevant studies without language or date restriction in May 2019. Human studies in which telemetric ICP monitoring was the main subject of the study were included. Our initial search resulted in 1650 articles from which 50 studies were included. There were no randomized controlled trials. The majority of the studies were case reports or case series (68%). The most common aim of studies was testing of the device (52%), and monitoring the disease progression or recovery (46%). The most common indications for telemetric ICP monitoring in these studies were testing cerebrospinal fluid shunt function (46%), ICP control after the procedure (36%), and diagnosing intracranial hypertension (22%) and hydrocephalus (12%). In total, 1423 brain disease patients had been monitored in studies. The possibility of long-term ICP monitoring as the main benefit was reported in 38 (76%) studies. The associated complication rate was 7.1%. Despite the increasing application of telemetric monitoring devices, studies to evaluate specific characteristics of this method have been infrequent and inadequate. Future research using a higher level of scientific methods is needed to evaluate advantage and disadvantages.

Idiopathic intracranial hypertension: Proposal of a stratification strategy for monitoring risk of disease progression

OBJECTIVES

A general consensus based on a multidisciplinary perspective involving an international panel was recently developed for management of patients with idiopathic intracranial hypertension (IIH). In this paper, the authors sought to develop further on the aspect of this consensus that concerns monitoring progression of the disease.

PATIENTS AND METHODS

A systematic literature review of previous publications on monitoring disease progression in IIH and a meta-analysis to examine efficacy of method of monitoring employed in each study. The authors present a brief descriptive analysis of challenges with monitoring progression of the disease and propose a risk stratification to aid monitoring.

RESULTS

Of a total of 382 publications identified from the literature search, only 8 studies (144 patients) satisfied inclusion criteria and were included for analysis. Among these, 3 were based on ICP monitoring while the remaining 5 focused on ophthamological evaluation. Interestingly, there were neither any studies on monitoring with progression of clinical features nor any study on monitoring with symptomatology associated with IIH among the selected studies.

CONCLUSION

There is a paucity of studies in the literature on methods of monitoring disease progression in IIH. Though close attention to adequate evaluation and proper care of patients with IIH remains the key in managing this problem, this proposed risk stratification will be an objective tool and useful guide to better monitor these patients according to their extent of risk from the disease and possibly for planning treatment and intervention.

Short-term continuous intraparenchymal intracranial pressure monitoring in presumed idiopathic intracranial hypertension

BACKGROUND

The management of idiopathic intracranial hypertension (IIH) depends on a reliable assessment of intracranial pressure (ICP), particularly when visual function measures or ophthalmoscopic indicators are confusing and when invasive surgical procedures are being considered. Although ICP monitoring has been widely applied in many neurologic conditions as a more reliable measure of ongoing ICP than lumbar puncture (LP), it has not often been widely used in the management of IIH.

METHODS

We searched the records of the University of Michigan between 2001 and 2008 for patients with IIH who had undergone LP and continuous ICP monitoring with an intraparenchymal Codman ICP Monitoring System and in whom at least 1 year of follow-up information was available. Ten patients met entry criteria.

RESULTS

There were no complications from the ICP monitoring. ICP monitoring influenced management in all 10 patients. In 8 patients, LP had shown elevated opening pressures; in 7 of them, ICP monitoring failed to confirm a consistently high ICP. In these patients, the decision to withdraw ICP-lowering agents or shunts, or not to revise indwelling shunts, produced no change in visual function or optic disc appearance over a follow-up period of at least 1 year. In 1 patient, ICP monitoring confirmed the high ICP suggested by LP, justifying placement of a ventriculoperitoneal shunt. In 1 patient, ICP monitoring was performed instead of LP because a petroclival mass posed a danger to the performance of LP; a shunt was subsequently placed due to elevated ICP.

CONCLUSION

In providing more accurate information about ICP than about LP, short-term continuous ICP intraparenchymal monitoring may be a useful adjunct in the management of IIH when clinical data are confusing and invasive interventions are under consideration.

Intracranial pressure monitoring and treatment: a contemporary view

ICP monitoring and recording provide another important parameter in the intensive care management of many critically ill patients and have been shown to augment the clinical neurologic examination, particularly in comatose patients suffering from severe head trauma, toxic and metabolic encephalopathies, massive cerebral infarctions, and many other central nervous system insults. Once considered an experimental tool restricted exclusively to sophisticated specialty neurosurgical and neuroanesthesia intensive care units, this straightforward and rapidly evolving technology is readily available and relatively easy to apply as a bedside intensive care procedure for selected patients. Many indications of particular interest to emergency physicians are indicated. The precise role of ICP monitoring in the prehospital management of patients has not been established. At this time, the conventional treatments for presumed ICP elevations, as outlined, are the mainstays of prehospital care. ICP monitoring may have a role in more extended or lengthy interinstitutional transfers of some critically ill patients.

Spectrum of benign intracranial hypertension in children and adolescents

A review of the most recent 23 cases of benign intracranial hypertension (BIH), admitted to the War Memorial Children's Hospital in London, Ontario, provided a compendium of the clinical manifestations of this disorder in children and adolescents. Although CT scanning lets one feel more secure in making such a diagnosis, pitfalls still exist. The sex ratio was 11 males to 12 females. Age groupings were: 0-6 years (2 patients); 7-12 years (10); 13-17 years (11). No postviral etiologies were encountered in patients more than 13 years of age. In only 6 cases could no definite etiology be established. Of great importance was the recognition of the condition in 12 patients who did not have papilledema. Elevated intracranial pressure was proven in 8 of these by lumbar CSF pressure monitoring, in 1 by lumbar punctures and in 1 infant with split cranial sutures. Absence of papilledema was confirmed by ophthalmological examination. Transient visual obscurations were very common in this group. In 6 patients, persistent signs and symptoms in spite of vigorous drug therapy prompted lumboperitoneal shunting, with immediate relief of symptoms in all. In only 1 case has the diagnosis of BIH proven to be in error. A warning leak from an aneurysm caused papilledema and headache, and a normal CT scan supported the diagnosis until the patient had a major hemorrhage weeks later. BIH has a variety of causes in children and adolescents, and papilledema is not a prerequisite for diagnosis.

The 1982 Silversides lecture. Problems in the diagnosis and treatment of pseudotumor cerebri

It is an honor to be asked to deliver the Silversides Lecture. Dr. Silversides’ clear understanding of the need for the collaboration of the basic and clinical sciences is a measure of the good sense for which he is admired. For a clinician, the greatest challenge to his clinical judgment lies in formulation of strategies to deal with vexing and serious conditions. Often we are called upon to treat conditions for which no satisfactory pathophysiologic mechanism has been elucidated. It is said that the clinician must frequently “get on top of the problem before he gets to the bottom of it.” In the spirit of all clinicians who seek better clinical approaches to poorly understood disease, I will devote this discussion to the diagnosis and treatment of pseudotumor cerebri.

Benign intracranial hypertension

Benign intracranial hypertension is caused by defective cerebrospinal fluid (CSF) absorption which may sometimes be secondary to partial superior sagittal sinus obstruction. It may appear in obese young women for obscure hormonal reasons or may be a reaction to head injury, infections or certain medications. It commonly presents with headache and papilloedema, sometimes with associated ocular palsies. Conservative management comprises repeated lumbar puncture, salt and fluid restriction and the use of diuretics or steroids. Surgical treatment such as CSF shunting procedures, optic nerve decompression or subtemporal decompression may become necessary. The results of treatment have not been subjected to adequate evaluation, but the patient usually recovers well, although some 10% suffer severe visual impairment and 10% are subject to recurrence.

Intracranial pressure in patients with the empty sella syndrome without benign intracranial hypertension

The intracranial pressure was monitored continuously for at least 48 hours in five patients with empty sella syndrome, who did not have clinical benign intracranial hypertension (BIH). It has been suggested that the empty sella syndrome is a result of chronically elevated intracranial pressure in the presence of a congenitally deficient diaphragma sellae. However, whilst the intracranial pressure in two of the five patients was abnormally high, in three patients in whom it was monitored, the CSF pressure was normal. Although these cases may represent "burnt out" forms of intracranial pressure problems, it might be that the normal pulsations of CSF are sufficient to produce the empty sella in the presence of a deficient diaphragma sella.