Article
Telemetric ICP home-monitoring in children – which ICP values are normal?
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Published: | June 4, 2012 |
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Objective: Since January 2010 we have the possibility of employing reliable and safe telemetric ICP-home-monitoring in children. No data exist for normal or pathological ICP values in long-time home monitoring or in special neurosurgical diseases. Here we report our experiences with normal and pathological ICP of children under daily life conditions.
Methods: Long-time ICP-home-monitoring was performed and analyzed for the first time in 15 children (mean age 8.3 yrs., range 2–14 yrs.) by the new Telemetric ICP monitoring system (Neurovent®-P-tel pressure probe, Raumedic AG, Helmbrechts, Germany). The mean implantation period of the probe was 65 days (range 8–209 days). In one case, long-time ICP-monitoring of the posterior fossa was performed.
Results: In 8 patients, the ICP values (5–15 mmHg) could exclude pathological ICP and further surgical procedures could be avoided. In 7 patients, repeated plateaus of raised ICP (25–35 mmHg) indicated ETV, shunt operation or decompressive craniotomy – resulting in a normalization of ICP in ongoing monitoring. Sensitive ICP-recording e.g. for B-wave analysis was easier during sleep at night. Negative values up to –10 mmHg without clinical symptoms were seen as normal in the upright position. The measurement of the posterior fossa showed a more negative baseline in upright position.
Conclusions: With the new telemetric ICP-monitoring system, a reliable ICP-monitoring is possible for the first time over many weeks, even at home. We found pathologically raised or negative ICP values and, after surgical treatment, reduction or normalisation with the alleviation of clinical symptoms. This positive success control helps us to understand these new insights into the childrens' brain physiology and will allow us in the future to better define normal and pathological ICP values under daily life conditions in different clinical entities.