Artikel
Intracranial pressure monitoring in the diagnosis of Pseudotumor cerebri syndrome
Intrakranielles Hirndruckmonitoring in der Diagnose des Pseudotumor cerebri Syndroms
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Autoren
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Manolis Polemikos
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Hans E. Heissler
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Elvis J. Hermann
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Joachim Kurt Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Pseudotumor cerebri syndrome (PTCS) mostly occurs in obese women of childbearing age. Usually, the diagnosis is established based on the presence of papilledema, an elevated opening pressure measured at lumbar puncture, a normal CSF composition and on the absence of pathological findings in MRI. Although it has been shown that continuous ICP monitoring can be a helpful adjunct, especially when findings are inconclusive or medical treatment fails, data on ICP dynamics in PTCS are sparse and their interpretation remains uncertain. The aim of this study is to highlight the utility of continuous ICP monitoring in diagnosing PTCS.
Methods: All adult patients with presumed PTCS in which ICP monitoring with an epidural sensor (Neurodur®, Raumedic) was performed between 2010 and 2020 were included. Clinical findings and ICP dynamics, emphasizing on baseline ICP, ICP fluctuations and the presence of ICP oscillations (A- and B-waves) were analysed. Baseline ICP values were defined as follows: normal (0-10 mmHg), elevated (11-20 mmHg), highly elevated (21-40 mmHg) and severely elevated (> 40 mmHg).
Results: Epidural ICP monitoring was performed in 42 patients (35 women and 7 men), with at least one nocturnal recording in every patient (range 1-5, median 2). There were no procedure related complications. Dislocation of the sensor occurred in 4 patients. Aided by the ICP dynamics the diagnosis of PCTS was confirmed in 35 patients, which subsequently received a ventriculoperitoneal shunt. ICP values in this group were normal in 4 (11,4 %), elevated in 9 (25,7 %), highly elevated in 16 (45,7 %) and severely elevated in 6 (17,1 %) patients. ICP- oscillations in the form of A-, B- and complex-waves formations were found in 10 (28,5%), 35 (100%) and 25 (71,4%) patients respectively. In 7 patients ICP investigation revealed normal values and guided the decision not to proceed with further surgical treatment.
Conclusion: Continuous epidural ICP monitoring is a safe and useful diagnostic tool for investigating PTCS patients especially in atypical cases and when surgical treatment is considered. An increased baseline ICP, large ICP fluctuations as well as the presence of ICP oscillations (A- and B-waves) during recordings can support the diagnosis of PCTS.
