Artikel
Measurement of intracranial pressure in children during different clinical scenarios
Kindliche Hirndruckmessung bei verschiedenen Indikationen
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Autoren
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C. Wiegand
- Neurochirurgie St. Augustin, St. Augustin, Germany
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P. Richards
- Department of Paediatric Neurosurgery, Oxford Children’s Hospital, Oxford, UK
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: There is no clear guidance on when and where to measure ICP in routine clinical practice in children. This abstract is targeted to give a clinically orientated overview of daily practice of ICP monitoring in a variety of situations.
Methods: N=589 Codman MicroSensor devices were inserted through a twist drill hole without bolt from 1995 to Juli 2007, and tunnelled to exit the scalp at a 4–5cm distance to the burr hole to minimize infection risk. Storage of data and inspection of wave forms and patterns, at least 24 h in a continuous fashion was provided by bedside laptop computers. In borderline cases measuring was extended up to 48 and 72 hrs. When assessing ICP a baseline consistently above 15 mmHg or more than three B-waves in a 24-hour period were considered to be indicative of raised ICP.
Results: There were basically two main indications for measuring ICP in children: Diagnostic uncertainty of potentially raised ICP after clinical and radiological evaluation and management of acutely raised ICP in children with encephalitis or head injury.
Devices were placed in cases (age 0-16 yrs., mean age 8,9 yrs) of head injury (14%, n=82), Shunt (dys)function (38%, n=224), arachnoid cysts (3%, n=18), premature neonates (2%, n=12), craniosynostosis (37%, n=218), Pseudotumor cerebri (3%, n=18), encephalitis (3%, n=18). No child experienced intracranial haemorrhage. There were n=2 episodes of neck stiffness within 7 days of the procedure presumingly due to infective meningitis and treated as such (0.34% of all inserted ICP devices).
Conclusions: Assessment of intracranial pressure (ICP) is essential in the management of acutely raised ICP. We would recommend that all children who are ventilated following head injury should have ICP monitoring. Early objective measurement of ICP allows decision making on the potential value of decompressive craniectomy, warning of intracranial haematomas or hydrocephalus, and helped to maximise CPP. ICP measurement is helpful where there is diagnostic uncertainty whether ICP is actually raised and to what level. The use of direct ICP monitoring was useful in determining the optimal amount and frequency of CSF drainage from infants with posthemorrhagic hydrocephalus. A sustained ICP over 7 mmHg was indicative of intracranial hypertension. Direct intraparenchymal ICP monitoring is technically straightforward, accurate, and carries a low risk.
