Lumbar Catheter for Monitoring of Intracranial Pressure in Patients with Post-Hemorrhagic Communicating Hydrocephalus
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Verena Speck • Dimitre Staykov • Hagen B. Huttner • Roland Sauer • Stefan Schwab • Juergen Bardutzky
- چاپ و سال / کشور: 2011
Description
Background We investigated the feasibility and accuracy of intracranial pressure (ICP)-measurement by lumbar drainage (LD) catheter in patients with post-hemorrhagic communicating hydrocephalus (PHCH). Methods Patients with subarachnoid hemorrhage (SAH, n = 21) or spontaneous ganglionic hemorrhage (ICH, n = 22) with ventricular involvement and the need for external ventricular drainage (EVD) due to acute hydrocephalus were included. When EVD weaning was not feasible due to persistent hydrocephalus, an additional LD was placed, after which EVD was clamped off. During this overlap period, patients underwent simultaneous pressure recording via EVD (‘‘EVD-ICP’’) and LD (‘‘LD-ICP’’). Testing included manual compression of the jugular veins and body-posture changes from supine to 30 position. After EVD removal, we evaluated sensitivity and specificity of ICP-rise >20 mmHg during continuous monitoring via LD for the detection of persistent PHCH using additional evaluation with computed tomography (CT). Results A total of 1,806 measurements were performed in 43 patients. ‘‘LD-ICP’’ was strongly correlated to ‘‘EVDICP’’, with determination coefficients R2 for the baseline measurements and each of the maneuvers ranging from 0.95–0.99, and slopes ranging 0.96–1.01. Sensitivity of ‘‘LD-ICP’’ >20 mmHg for detection of persistent PHCH as compared to CT was 81% and specificity was 100%. Two patients with severe SAH developed reversible signs of herniation after gradually increasing differences between ‘‘LD-ICP’’ and ‘‘EVD-ICP’’ indicated a cranio-spinal pressure gradient, likely due to cerebrospinal fluid overdrainage via LD. Conclusion ICP measured via LD highly and reliably correlated to ICP measured via EVD in patients with PHCH.
Neurocrit Care (2011) 14:208–215 DOI 10.1007/s12028-010-9459-6 Published online: 16 October 2010
