gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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A standardized outpatient ICP monitoring using the standing-supine-sitting-paradigm in clinical practice

Meeting Abstract

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  • Sebastian Müller - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Christian von der Brelie - Neurochirurgische Klinik, Universitätsklinik Schleswig-Holstein, Campus Kiel, Deutschland; Neurochirurgische Universitätsklinik Göttingen, Göttingen, Deutschland
  • Florian B Freimann - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Bawarjan Schatlo - Universitätsklinik Göttingen, Klinik f. Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.04.06

doi: 10.3205/17dgnc025, urn:nbn:de:0183-17dgnc0254

Published: June 9, 2017

© 2017 Müller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: A minority of patients with ventriculoperitoneal shunts suffer from symptoms of positional over- or underdrainage. Fine-tuning shunt settings despite programmable valves and gravitational assistance can be difficult. The introduction of telemetric intracranial pressure (ICP) recordings has allowed us to improve shunt therapy in this subgroup of patients. In order to standardize ICP measurement conditions, we devised a simple and repeatable manoeuver for outpatient telemetric ICP recording and assessed test-retest reliability and clinical utility.

Methods: The standing-supine-sitting-paradigm requires postural changes in 10-minute intervals over 30 minutes. All ICP measurements (Neurovent-P-tel system, Raumedic) were analyzed using a dedicated freeware tool. Valve adjustments and their clinical impact were assessed. The test re-test reliability was assessed by consecutive measurements without shunt adjustments.

Results: Overall test re-test reliability was excellent (Pearson´s correlation coefficient 0.95, p<0.001). We evaluated 165 ICP measurements in 18 patients with a mean age of 36 years (range 25-65). Clinical intracranial hypotension in 21 measurements was associated with a mean ICP of (standing) -12.5±6.5mmHg, (supine) 4.3±6.5mmHg and (sitting) -11.5±7.1mmHg. In patients with moderate symptoms, measurements revealed a standing pressure of -6.4±4.6mmHg, supine pressure of 10.5±4.4mmHg and a sitting pressure of -4.8±2.6mmHg. In patients with assumed intracranial hypertension, 20 measurements were performed and revealed a mean ICP of 1.7±6.4mmHg in the standing, 15.6±5.1mmHg in the supine and -0.9±6.0mmHg in the sitting position. Twenty-nine shunt valve adjustments resulted from these measurements and led to improvement in clinical symptoms in 19 cases (65%) after valve adjustment.

Conclusion: We confirmed the test-retest reliability of the “stand-supine-sit”-paradigm. The interpretation of ICP values in this highly selected patient cohort poses a formidable challenge even on the individual level. Generalizations obtained from this pooled dataset are difficult. However, we obtained modest symptom improvement based on measurements in about two thirds of patients based on our recordings.