Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients

Abstract

Shunt surgery is the primary treatment of pediatric and adult hydrocephalus, 42 although shunt failure requiring shunt revision is frequent. 2,8,12,45 Shunt failure may be accompanied by over-or underdrainage of CSF. When the shunt is draining too much CSF (overdrainage), symptoms such as headache and dizziness may arise. 9,37 However, symptoms such as headache and dizziness may also be caused by CSF underdrainage, e.g., due to obstruction of the CSF catheter. 10 The shunt valves with adjustable CSF opening pressure have been reported to reduce the occurrence of shunt failures. 48 However, in a recent randomized controlled dual-center trial, 39 we found the same rate of shunt complications and overdrainage symptoms in patients with hydrocephalus receiving a shunt with a fixed valve setting of 13 cm H 2 O, as compared with those in whom gradual lowering of the valve setting to a mean of 7 cm H 2 O was performed. These results highlight the need for a better understanding of how shunts influence in- obJect In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. methods The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms.results The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%).Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than −5 to −10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any significant association with age. coNclusioNs In this coho...

Complications following intracranial pressure monitoring in children: a 6-year single-center experience

“…ince its introduction in the 1950s, 14 continuous intracranial pressure (ICP) monitoring has become an important tool in the modern neurosurgeon's armamentarium. It has been used for various indications, including trauma, 2,3 assessment of hydrocephalus, 9 shunt function, 17 and craniosynostosis, 21 in both adult and pediatric populations.…”

“…Many studies look at the potential for zero drift over time and show that, on the whole, it is relatively minor (median drift 1-2 mm Hg over an average of 7-9 days), 1,10,13,18 with good correlation between intraventricular and intraparenchymal pressure readings. 13,20 Many studies have evaluated the efficacy of such ICP monitors, especially the Camino device, 3,4,9,17 but very few look at the overall complication rates for these devices, especially in pediatric populations.…”

Slit Ventricle as a Neurosurgical Emergency: Case Report and Review of Literature

“…We aimed to highlight the importance of ICP measurement 33,34 to define the pathophysiologic background of shunt malfunction and to give an overview of the literature about possible mechanisms of slit ventricle syndrome, which is a special case of shunt failure.…”

Reference Values For Intracranial Pressure And Lumbar Cerebrospinal Fluid Pressure: A Systematic Review

“…Measurement and analysis of intracranial pressure (ICP) are used to inform treatments and management of numerous neurosurgical diseases, e.g., traumatic brain injury, acute intracranial hemorrhages, idiopathic intracranial hypertension, and hydrocephalus [1][2][3][4]. However, values for normal ICP measured intracranially remain sparsely documented, and the currently used reference interval (7 to 15 mmHg [5]) are based on studies in which lumbar cerebrospinal uid opening pressure (LCSF op ) is used as a surrogate parameter for ICP or extrapolated from patients with a suspected ICP disorder [5][6][7][8][9][10][11].…”