gms | German Medical Science

Objective: Assessment of intracranial pressure (ICP) is essential in children with different causes of increased ICP as traumatic brain injury, premature intraventricular haemorrhage and hydrocephalus. The usual technique in children, under the age of one, is either a direct measurement with invasive intracranial insertion of ICP-probes or indirect non-invasively with transfontanel ultrasound blood flow measurement. We present a technique, which allows non-invasive percutaneous transfontanel ICP measurement with common ICP-probes.

Method: The intraparenchymatous Spiegelberg-ICP-probe was placed over the large frontal fontanel and fixated with a stiff spatula and a tape, which closed the gap between the bone plates. In order to evidence that the measured pressure corresponds with the true ICP, two clinical setups were investigated. In the first setup the transfontanel ICP monitoring was compared with epidural monitoring in children with craniosynostosis, where the ICP probe was standardly placed epidural. In the second setup ICP was compared with a CSF puncture of a ventricular reservoir in children with hydrocephalus after premature intraventricular haemorrhage.

Results: There was no significant difference in the monitored ICP between transfontanel and epidural measurements in children with craniosynostosis within a range of 2 mmHg (n=14, mean ICP transfontanel:16.21 mmHg, SEM=2.70, mean ICP epidural: 15.75 mmHg). In the comparison between transfontanel and direct puncture we showed also no significant different ICP within a range of 2 mmHg (ICP postpuncture: n=6, transfontanel 4.1 mmHg, puncture 4.50 cmH₂O, e.g. 3.31 mmHg). The calculation factor between cmH₂O and mmHg was 1.36 mmHg.

Conclusions: The percutaneous transfontanel measured ICP is a reliable method which allows to monitor the ICP non-invasively in children under the age of one year.