1
|
Pedersen SH, Henriksen KA, Gustafsen SD, Hansen TS, Guldager R, Juhler M. Telemetric ICP monitoring in children: a national questionnaire-based study. Childs Nerv Syst 2024:10.1007/s00381-024-06383-y. [PMID: 38587626 DOI: 10.1007/s00381-024-06383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Telemetric monitoring of intracranial pressure (ICP) facilitates long-term measurements and home monitoring, thus potentially reducing diagnostic imaging and acute hospital admissions in favour of outpatient appointments. Especially in paediatric patients, telemetric ICP monitoring requires a high level of collaboration and compliance from patients and parents. In this study, we aim to systematically investigate (1) patient and parent perception of telemetric ICP system utility and (2) hospital contact history and thus the potential cost-benefit of telemetric ICP monitoring in paediatric patients with a cerebrospinal fluid disorder. METHODS We conducted a nationwide questionnaire study, including paediatric patients with either a current or previous telemetric ICP sensor and their parents. Additionally, a retrospective review of electronic health records for all included children was performed. RESULTS We included 16 children (age range 3-16 years), with a total of 41 telemetric ICP sensors implanted. Following sensor implantation, the frequency of telephone contacts and outpatient visits increased. No corresponding decrease in hospital admissions or total length of stay was found. The telemetric ICP sensor provided most parents with an improved sense of security and was seen as a necessary and valuable tool in treatment guidance. The size and shape of the sensor itself were reported as disadvantages, while the external monitoring equipment was reported as easy to use but too large and heavy for a child to carry. CONCLUSION Though, in quantitative terms, there was no cost-benefit of the telemetric ICP sensor, it contributed to extended parental involvement and a sense of improved safety.
Collapse
Affiliation(s)
- Sarah Hornshøj Pedersen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Kasper Amund Henriksen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Sara Duus Gustafsen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Torben Skovbo Hansen
- Department of Neurosurgery, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Rikke Guldager
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| |
Collapse
|
2
|
Juhler M, Hansen TS, Novrup HVG, MacAulay N, Munch TN. Hydrocephalus Study Design: Testing New Hypotheses in Clinical Studies and Bench-to-Bedside Research. World Neurosurg 2022; 161:424-431. [PMID: 35505563 DOI: 10.1016/j.wneu.2021.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 10/18/2022]
Abstract
In this article, we aimed to describe some of the currently most challenging problems in neurosurgical management of hydrocephalus and how these can be reasons for inspiration for and development of research. We chose 4 areas of focus: 2 dedicated to improvement of current treatments (shunt implant surgery and endoscopic hydrocephalus surgery) and 2 dedicated to emerging future treatment principles (molecular mechanisms of cerebrospinal fluid secretion and hydrocephalus genetics).
Collapse
Affiliation(s)
- Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hans V G Novrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
3
|
Perrotte M, Lazardeux J, Sistiaga PP, Chazalviel L, Saulnier R, Metayer T, Isnard C, Emery E, Auvray P, Vivien D, Gaberel T. An updated model of hydrocephalus in sheep to evaluate the performance of a device for ambulatory wireless monitoring of cerebral pressure through shunts. Neurochirurgie 2021; 68:300-308. [PMID: 34774581 DOI: 10.1016/j.neuchi.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) diversion by shunts is the most common surgical treatment for hydrocephalus. Though effective, shunts are associated with risk of dysfunction leading to multiple surgical revisions, affecting patient quality-of-life and incurring high healthcare costs. There is a need for ambulatory monitoring systems for life-long assessment of shunt status. The present study aimed to develop a preclinical model assessing the feasibility of our wireless device for continuous monitoring of cerebral pressure in shunts. METHODS We first adapted a previous hydrocephalus model in sheep, which used an intracisternal kaolin injection. Seven animals were used to establish the model, and 1 sheep with naturally dilated ventricles was used as control. Hydrocephalus was confirmed by clinical examination and brain imaging before inserting the ventriculoperitoneal shunts and the monitoring device allowing continuous measurement of the pressure through the shunt for a few days in 3 sheep. An external ventricular drain was used as gold-standard. RESULTS Our results showed that a reduction in kaolin dose associated to postoperative management was crucial to reduce morbidity and mortality rates in the model. Ventriculomegaly was confirmed by imaging 4 days after injection of 75 mg kaolin into the cisterna magna. For the implanted sheep, recordings revealed high sensitivity of our sensor in detecting fluctuations in cerebral pressure compared to conventional measurements. CONCLUSIONS This proof-of-concept study highlights the potential of this preclinical model for testing new shunt devices.
Collapse
Affiliation(s)
- Morgane Perrotte
- Research and Development Department, Neurallys, Colombelles, Normandie, France.
| | - Johan Lazardeux
- Research and Development Department, Neurallys, Colombelles, Normandie, France
| | | | - Laurent Chazalviel
- UMR6301-ISTCT, CNRS, CERVOxy Group, GIP Cyceron, Caen, Normandie, France
| | | | - Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
| | - Christophe Isnard
- Department of Microbiology, University Caen-Normandy, UNICAEN, University Hospital of Caen, Caen, Normandie, France; UNICAEN/UNIROUEN, EA2656 GRAM 2.0, University Caen-Normandy, Caen, Normandie, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
| | - Philippe Auvray
- Research and Development Department, Neurallys, Colombelles, Normandie, France
| | - Denis Vivien
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France; Department of Clinical Research, University Hospital of Caen, Caen, Normandie, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
| |
Collapse
|
4
|
Malfatti G, Racano E, Delle Site R, Gios L, Micocci S, Dianti M, Molini PB, Allegrini F, Ravagni M, Moz M, Nicolini A, Romanelli F. Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution. PLoS One 2021; 16:e0257250. [PMID: 34506578 PMCID: PMC8432860 DOI: 10.1371/journal.pone.0257250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. OBJECTIVE In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. METHODS A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. RESULTS Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. CONCLUSIONS The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.
Collapse
Affiliation(s)
- Giulia Malfatti
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Roberta Delle Site
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Lorenzo Gios
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | | | - Marco Dianti
- Fondazione Bruno Kessler, Digital Health Lab, Povo, Italy
| | | | - Francesca Allegrini
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Mariangela Ravagni
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| | - Monica Moz
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Andrea Nicolini
- TrentinoSalute4.0, Competence Center for Digital Health of the Province of Trento, Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, U.O. di Oculistica, Ospedale di Rovereto, Trento, Italy
| |
Collapse
|
5
|
Velazquez Sanchez VF, Al Dayri G, Tschan CA. Long-term telemetric intracranial pressure monitoring for diagnosis and therapy optimisation of idiopathic intracranial hypertension. BMC Neurol 2021; 21:343. [PMID: 34493231 PMCID: PMC8424907 DOI: 10.1186/s12883-021-02349-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a disease which is difficult to diagnose and moreover difficult to treat. We developed a strategy for long-term telemonitoring of intracranial pressure (ICP), by incorporation of the NEUROVENT®-P-tel System, with the goal of improved diagnosis and consequent therapy of this disease. We highlight the results obtained through this approach. Methods Twenty patients with suspected IIH who were treated in our hospital from August 2014 to October 2020 (16 females, 4 males, median age 36,6 years), were assigned to one of two ICP monitoring settings, “Home-Telemonitoring” (n = 12) and “Home-Monitoring” (n = 8). The ICP data were analysed and used conjointly with the accompanying clinical picture for establishment of IIH diagnosis, and telemonitoring was resumed for therapy optimisation of confirmed cases. Results The diagnosis of IIH was confirmed in 18 of the 20 patients. Various surgical/interventional treatments were applied to the confirmed cases, including ventriculoperitoneal (VP) shunting (n = 15), stenting of the transvers venous sinus (n = 1), endoscopic third ventriculostomy (ETV) (n = 1), and ETV in combination with endoscopic laser-based coagulation of the choroid Plexus (n = 1). Optimal adjustment of the implanted shunt valves was achieved with an average valve opening pressure of 6,3 ± 2,17 cm H2O for differential valves, and of 29,8 ± 3,94 cm H2O for gravitational valves. The Home-Telemonitoring setting reduced consequent outpatient visits, compared to the Home-Monitoring setting, with an average of 3,1 visits and 4,3 visits, respectively. No complications were associated with the surgical implantation of the P-tel catheter. Conclusion This study offers insight into the use of long-term ICP monitoring for management of IIH patients in combination with dual-valve VP shunts. The use of NEUROVENT® P-tel system and potentially other similar fully implantable ICP-monitoring devices, albeit invasive, may be justified in this complex disease. The data suggest recommending an initial adjustment of dual-valve VP-shunts of 30 and 6 cm H2O, for gravitational and differential valves, respectively. Further research is warranted to explore potential integration of this concept in IIH management guidelines.
Collapse
Affiliation(s)
- Victor F Velazquez Sanchez
- Department of Neurosurgery and Spine Centre in Ludmillenstift Hospital in Meppen, Ludmillenstrasse 4-6, 49716, Meppen, Germany
| | - Giath Al Dayri
- Department of Neurosurgery and Spine Centre in Ludmillenstift Hospital in Meppen, Ludmillenstrasse 4-6, 49716, Meppen, Germany
| | - Christoph A Tschan
- Department of Neurosurgery and Spine Centre in Ludmillenstift Hospital in Meppen, Ludmillenstrasse 4-6, 49716, Meppen, Germany.
| |
Collapse
|
6
|
Kommer M, Boulton RG, Loi L, Robinson S, Hawthorne C, Shaw M, Piper I, Moss L, Amato-Watkins A, Campbell E, Sangra M, O'Kane R. Telemetric Intracranial Pressure: A Snapshot Does not Give the Full Story. Acta Neurochir Suppl 2021; 131:323-4. [PMID: 33839867 DOI: 10.1007/978-3-030-59436-7_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Telemetric intracranial pressure (ICP) monitors are useful tools in the management of complex hydrocephalus and idiopathic intracranial hypertension (IIH). Clinicians may use them as a "snapshot" screening tool to assess shunt function or ICP. We compared "snapshot" telemetric ICP recordings with extended, in-patient periods of monitoring to determine whether this practice is safe and useful for clinical decision making.
Collapse
|
7
|
Affiliation(s)
- Joachim M K Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.
| | - Matthias J M Huelser
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| |
Collapse
|