gms | German Medical Science

Objective: Treated as well as untreated hydrocephalic patients often present with misleading and complex symptoms. Consecutively, invasive measurements of the ICP become necessary. However, the problem is that conventional measuring probes are usually intended for short-term use. Follow-up observation of the ICP to control therapy success is impossible so far. Therefore, the aim of the presented study was to evaluate whether diagnostic and therapeutic management of hydrocephalus can be supported by a fully-implantable telemetric ICP measurement device.

Method: A total of 164 telemetric ICP measurement probes (Raumedic Neurovent P-tel) were implanted in frontal white matter of patients with suspected (n=96) or known (n=68) hydrocephalus. Indications for using the telemetry as part of the primary diagnosis were suspected normal-pressure hydrocephalus (n=54), occlusive hydrocephalus (n=26), benign intracranial hypertension (n=6) or miscellaneous (n=10). In already shunt-treated patients, the P-tel probe was applied to exclude shunt-dysfunctions (n=28) or -overdrainages (n=21). The other 19 telemetry catheters were inserted parallel to first time shunt implantations (n=6) or endoscopic procedures (n=13) to monitor the postoperative course. Telemetric ICP data of each patient were recorded and evaluated in a standardized form.

Results: In all 164 patients, plausible and reliable ICP values could be measured. Sixty-two first-time shunt implantations and 15 endoscopic third ventriculostomies evolved from preoperative diagnostic ICP measurements. In 28 shunt-treated patients, suspected dysfunctions could be confirmed in 22 cases. All supposed overdrainages were verified by measuring supernegative ICP values. After subsequent valve replacements or adjustments, improvement of the ICP profile and the patients’ clinical condition could be observed. The postoperative recordings after first time shunt implantation could show regular ICP profiles in all cases. Telemetric monitoring after endoscopy (n=28) could reveal ventriculostomy-failures in 8 patients.

Conclusions: The new telemetric ICP monitoring system is a precious diagnostic tool in hydrocephalic patients. The given possibility to perform uncomplicated long-term ICP measurements can lead to new developments in the diagnostic and therapeutic management of the complex disease.