gms | German Medical Science

Objective: As technical progress advances, telemonitoring has become a important part of patient care in many areas medical treatment. Here we report on a new home monitoring setup which enables for the first time telemonitoring of intracranial pressure (ICP).

Method: 15 patients with complex hydrocephalic conditions, 9 female and 5 male, median age 32 years of age (from 13 to 53 years of age) with a ICP probe implanted (P-tel^®, Raumedic AG, Germany) were provided with the medical equipment to read the ICP at home and transfer the data to a internet enabled computer. The data can be transferred for post measurement analysis or on-line / live evaluation. Training in handling the equipment was performed during inpatient stay. For the telemonitoring a neurosurgeon was able access to the ICP data over a secure internet connection while telephone- or video-conferencing with the patient. Etiologies of the patients conditions were: occlusive hydrocephalus with stenosis of the aqueduct (n=5), pseudotumor cerebri (n=4), shunt dysfunction and over drainage (n=6), treatment with endoscopic third venticulostomy (ETV) (n=6) intractable cephalgia with suspected elevated intracranial pressure (n=3).

Results: Over 2810 hours of home ICP monitoring were performed and evaluated, a median of 220 hours (50 hours to 400 hours) per patient. Changes or adjustment in the ICP values and profiles were observed up to 3 months under monitoring after treatment by ETV or shunting. Long distance patient monitoring and treatment was possible. A median distance of the patient's residence to the clinic was 83 km (from 10 km to 624 km). Telemetric ICP readings provided important information in emergency decision making situations in 2 incidents.

Conclusions: For the first time in neurosurgical history ICP measuring is accessible in a telemonitoring setting. In treatment of challenging hydrocephalic conditions telemonitoring offers a beneficial method in patient care. This is especially valuable for specialized centers which treat patients from greater distance. Though the evaluation of the ICP data and telephone conference with the patient is time consuming, it reduced outpatient visits and makes it possible to monitor the patient in every-day situations. In our experience telemetric ICP home monitoring provides a feasible and safe way of outpatient treatment.