Changing the paradigm of intracranial hypertension in brain tumor patients: a study based on non-invasive ICP measurements

Abstract

Background The ultrasound based non-invasive ICP measurement method has been recently validated. Correlation of symptoms and signs of intracranial hypertension with actual ICP measurements in patients with large intracranial tumors is controversial. The purpose of this study was to assess ICP in patients with brain tumors, presenting with neurological signs and symptoms of elevated ICP and to further evaluate the value and utility of non-invasive ICP monitoring. Methods Twenty patients underwent non-invasive ICP measurement using a two-depth transcranial Doppler ultrasound designed to simultaneously compare pulse dynamics in the proximal (intracranial), and the distal (extracranial) intraorbital segments of the ophthalmic artery through the closed eyelid. Results Forty-eight measurements were analyzed. Radiological characteristics included tumor volume (range = 5.45–220.27cm3, mean = 48.81 cm3), perilesional edema (range = 0–238.27cm3, mean = 74.40 cm3), and midline shift (mean = 3.99 mm). All ICP measurements were in the normal range of 7–16 mmHg (ICPmean: 9.19 mmHg). The correlation of demographics, clinical and radiological variables in a bivariate association, showed a statistically significant correlation with neurological deficits and ICPmax (p = 0.02) as well as ICPmean (p = 0.01). The correlation between ICP and neurological deficits, showed a negative value of the estimate. The ICP was not increased in all cases, whether ipsilateral nor contralateral to the tumor. The multivariate model analysis demonstrated that neurological deficits were associated with lower ICPmax values, whereas maximum tumor diameter was associated with larger ICPmax values. Conclusions This study demonstrated that ICP in patients with intracranial tumors and mass effect is not necessarily increased. Therefore, clinical signs of intracranial hypertension do not necessarily reflect increased ICP.

O Uso De Novas Tecnologias Não Invasivas Para a Monitorização E Diagnóstico Da Hipertensão Intracraniana Em Pacientes Críticos

“…Em relação ao tipo de estudo, cinco (31,2%) eram estudos clínicos experimentais (DIXON et al, 2023;MLÁDEK et al, 2021;DAĞDELEN et al, 2022;KOSTICK et al, 2021;CARDIM et al, 2019), quatro (25%) eram estudos clínicos piloto (KIENZLER et al, 2019;LUCINSKAS et al, 2021;KIENZLER et al, 2020); dois (12,5%) estudos eram relatos de caso (DHAESE et al, 2021;PARAGUASSU et al, 2021) e outros três (18,75%) como estudo piloto de viabilidade, estudo transversal de centro único e estudo observacional prospectivo.…”

“…Três estudos (DHAESE et al, 2021;PARAGUASSU et al, 2021;BRASIL et al, 2023) monitoraram a pressão intracraniana e condições disfuncionais, como a hipertensão intracraniana e cefaleia, através de um dispositivo capaz de monitorar a onda de percussão, relacionada a transmissão da pressão arterial do plexo coróide para os ventrículos, onda de maré, relacionada à complacência intracraniana, e onda dicrótica, relacionada ao fechamento da válvula aórtica durante a diástole. Dois estudos (KIENZLER et al, 2019;KIENZLER et al, 2020) utilizaram um tipo de Doppler transorbital personalizado equipado com um transdutor de feixe único para monitorar o aumento da pressão intracraniana no traumatismo cranioencefálico e em pacientes com tumor cerebral.…”

Intraparenchymal fiberoptic intracranial pressure monitoring and decompressive craniectomy in meningioma case with critical intracranial pressure: A case report during COVID-19 pandemic

“…A recent study on ICP measurement in brain tumor cases utilized transcranial doppler instead. However, the authors of that study concluded that clinical signs of intracranial hypertension did not always imply an increase in ICP [9] . In contrast to this study, the present case showed compatibility of clinical features and actual ICP.…”

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

“…3), headaches that are worse in the morning, nausea and vomiting, abnormal eye movements, pupillary changes, seizures, and altered mental status are classic signs of intracranial hypertension [2] but not all patients with raised ICP present similarly [13]. In addition, not all patients presenting with signs of intracranial hypertension demonstrate such an increase on non-invasive ICP monitoring [14]. Infratentorial lesions may require urgent attention because small amounts of edema can result in severe neurological compromise and altered mentation given their proximity to the brainstem and aqueduct of Sylvius.…”