Authors: Thomas W. Larrew, MD
Intracranial pressure (ICP) monitoring has commonly been utilized for identifying pathologic ICP in cases of traumatic brain injury; however, its use in management of cases of hydrocephalus where imaging and clinical symptoms are ambiguous has not been extensively researched. The purpose of this study was to investigate the utility of ICP monitoring as a diagnostic modality for the surgical management of patients with ventriculomegaly of equivocal clinical significance.Methods: 36 patients (? 17 years old) underwent 37 ICP recording sessions between 2016 and 2021 and were retrospectively reviewed. This included patients with a history of severe ventriculomegaly but lacking symptoms concerning for pathologic ICP. All patients had normal fundoscopic examination. Nighttime pathological plateau waves were indicative of poor brain/CSF compliance during hyperemic sleep episodes.
The mean age of patients was 5.5 years old (range 0-17 years old), 43.2% of whom had prior endoscopic third ventriculostomy (ETV), 16.2% with prior ventriculoperitoneal shunt (VPS), and 40.5% without prior surgical intervention. Mean length of stay was 2.8 days (?0.7 days). Pathologic ICP was demonstrated in 10 cases (27%), 7 (70%) of which were asymptomatic. Pathologic ICP was found in 6 of 16 (37.5%) in the prior ETV group, 1 of 6 (16.7%) in prior shunt group, and 3 of 12 (20%) in the non-surgical group (p=.538). Among those with pathologic ICP, 5 (50%) cases received an ETV and 5 (50%) of cases received a VPS. Complications included ICP monitor dislodgement in 4 patients and subsequent protocol changes have been implemented.
Inpatient ICP monitoring is a safe and effective diagnostic tool for evaluating persistent ventriculomegaly. The use of ICP monitoring in patients with ventriculomegaly can provide important and otherwise unobtainable information needed to determine if the patient has solely ventriculomegaly or pressure-compensated hydrocephalus and if surgical intervention is necessary.