04 icp monitoring

7/29/2019 04 ICP Monitoring

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Intracranial pressure: measurement and

monitoring.

CSF pressure as a golden standard.Intraparenchymal pressure. Sensors, drifts,

errors and monitoring techniques


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Lundberg N. Continuous recording and control of ventricular fluid

pressure in neurosurgical practice. Acta Psychiat Neurol

Scand1960;36(suppl 149):1

193.

GUILLAUME J, JANNY P.

[Continuous intracranial manometry; physiopathologic and clinical significance of the

method]. Presse Med. 1951 Jul 4;59(45):953-5


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Monitoring of CSF pressure: instant manometric

CSF column measurement is inadequate

Owler BK, Fong KC, Czosnyka Z. Importance of ICP monitoring in the investigation of CSFcirculation disorders.Br J Neurosurg. 2001 Oct;15(5):439-40


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Golden standard: ventricular CSF pressure or Lumbar CSF pressure

Thanks to Dr. DJ Kim


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Fluid filled line connected to CSF space

(ventricular or lumbar) with external pressure

transducer

Advantages:

1. Possible re-calibration and zeroing

2. Possible check of patency

Disadvantages:

1. Risk of infection

2. Low frequency bandwidth


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Thanks to Dr. K Aquilina

Problems with CSF pressure monitoring

through intraventricular catheter


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Microtransducers- early solutions


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Thanks to Mr P.Hutchinson


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Thanks to Ms D. Tangun


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Example- diameters and setup

Thanks to Dr. R.Penn


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Thanks to Ms. Christele Nardo


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Thanks to Ms. Christele Nardo


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Principle:Transmission of pressure from

inside the body to the outsidethrough air.

Partially filled air-pouch transmits

pressure to the air-column.

First published by EJ Marey, 1881.

Thanks to Dr. A.Spiegelberg

Spiegelberg ICP

transducer


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Thaks to Mr.K.Aquilina


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Telemetryearly solutions


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March 16 March 23 March 30 April 6 April 13 April 20 April 27 May 4 May 11

Intracranial Pressure vs. Time in Asymptomatic Shunted Patients

Time (Days)

Long term telemetric ICP monitoring

Thanks to Dr. D.Frim


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Rotterdam Transfontanelle ICP transducer


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Cambridge Shunt Evaluation Lab- testing of ICP

microtransducers


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24 h ti d ift


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Comparison of 3 microtransducers (A-Camino, B-Codman, C- Fiberoptic Ventrix)

24-hours time drift


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Temperature drift of Camino transducer


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Static and dynamic accuracy of transducer can be measured in laboratory

ICP is related to body posture


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ICP

[mmHg]

20

0

-10

Awake- sitting Asleep- horizontal

ICP is related to body posture


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ICP[mm HG]

15

0

Normal ICP in horizontal (left) and in

sitting up position (right)


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Statistics: 63 non-shunted patients


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Lumbar

[mmHg]

Tissue

[mmHg]

CSF versus intraparenchymal pressure


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Lumbar [mm Hg]

Tissue [mm Hg]

Cross spectrum

[mm Hg]

Transfer

Lumbar/Tissue


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Phase shift between lumbar pulse and parenchymal pulse

Lumbar

[mm Hg]

Tissue[mmHg]


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What intraparenchymal microsensor really measures

Pressure in water- scalar

Pressure in brain- tensor


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Monitoring through EVD versus intraparenchymal probe

Thanks to Prof.JD.Pickard


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A B

C D

Various forms of focal venous sinus obstruction in the transverse sinuses of 4 patients. Intrinsic filling

defects are obvious in the top two radiographs being an arachnoid granulation (A) and a broad based

undulating lesion (B). Of the lower two, the radiograph on the left (C) could be a focal stricture or

extrinsic compression while the radiograph on the right (D) appears to indicate secondary venous sinus

compression or irregularity due to old thrombus.

Coupling between ICP and Sagittal Sinus Pressure investigated in Idiopathic Intracranial Hypertension


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[mm Hg]

[mmHg]

Pss


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Relationship between slow waves of Pcsf and Psss (at baseline)

[mmHg]

ICP

Pss

ICP

Pss


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Correlation between baseline pressures


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ICP monitoring artefacts. Tracheal suction

ICP

mmHg


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Coughing

mmHg

ICP

Shigekuni Tachibana Hideo Iida and Kenzoh Yada Significance of positive Queckenstedt


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Shigekuni Tachibana, Hideo Iida and Kenzoh Yada. Significance of positive Queckenstedt

test in patients with syringomyelia associated with Arnold-Chiari malformations

Journal ofNeurosurgery, January 1992, Vol. 76, No. 1, Pages 67-71


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Summary

Manometric lumbar assessment may be misleading

Definition: ICP= CSF pressure in ventricles measured in horizontal position

Variations: Intraparenchymal pressure, lumbar CSF pressure, transfontanelle pressure

Intraparenchymal transducers measure vector of force not pressure!

Advantages: long term stability, low infection risk

Sagittal sinus pressure: always stable?

ICP depends on body posture and activity

Artefacts: mainly dependent on changes in venous pressure

04 icp monitoring

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