Article
Clinical consequences and operative strategies in pediatric patients under long-time telemetric ICP monitoring
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Published: | April 28, 2011 |
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Objective: No reference values for telemetric ICP home monitoring in children exist so far. For the first time, we now have the possibilty of measuring the ICP in a safe and reliable home monitoring setting. Here we report on indications for telemetric ICP home monitoring, first long-time results and therapeutic consequences in pediatric neurosurgery.
Methods: The telemetric long-time home measurement was performed in 13 patients (mean 7,6y, range 2–14y) over a mean of 59 days (range 8–209 d). The intraparenchymal ICP probe was applied over a small burrhole, the telemetric transducer was placed under the galea. Parents were trained in the handling of the data storage and monitoring system (Raumedic AG, Helmbrechts, Germany). A diary for headache or adverse events was kept by the patients or parents. The long-term data were analysed weekly up to a monthly interval. All data were statistically analyzed using SPSS and Windows Excel 2007.
Results: The indications for implantation of a telemetric ICP probe were suspected hydrocephalus (n=4), supervision of adequate shunting of ETV (n=2), shunt ligation, (n=2) and suspected shunt dysfunction (n=2), severe head trauma (n=1) and craniosynostosis (n=2). In five patients the measurement is still ongoing. 5 patients were found to have normal ICP, although further surgical procedures were already planned ahead of the implantation in 3 of these cases. Most pathological ICP patterns were found in the overnight measurements. The monitoring discovered ETV failure, shunt dysfunction and ICP-independent headaches or suspected papilledema. In 7 out of our 13 patients, the diagnostic post-implantation measurement led to neurosurgical interventions, in 5 cases the home monitoring served as a therapeutic tool to improve the fine adjustment of VP-shunt valves.
Conclusions: This new technology allows the physician a first reliable and patient-friendly long-term ICP home monitoring in children. As a diagnostic tool, the telemetric monitoring resulted in faster identification of pathologic ICP patterns and consequently more efficient and faster neurosurgical management. In all children, a correct diagnosis could be made so that further neurosurgical interventions could be either avoided (when ICP was normal), or, where surgical interventions were necessary, the normalization of postoperative ICP could be proved in all cases.