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Telemetric intracranial pressure monitoring in children

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Abstract

Purpose

Repeated intracranial pressure (ICP) measurements are essential in treatment of patients with complex cerebrospinal fluid (CSF) disorders. These patients often have a long surgical history with numerous invasive lumbar or intracranial pressure monitoring sessions and/or ventriculoperitoneal (VP) shunt revisions. Telemetric ICP monitoring might be an advantageous tool in treatment of these patients. In this paper, we evaluate our experience with this technology in paediatric patients.

Methods

During a 4-year period, we implanted telemetric ICP sensors (Raumedic NEUROVENT-P-tel) in 20 paediatric patients to minimise the number of future invasive procedures. Patients were diagnosed with hydrocephalus, idiopathic intracranial hypertension (IIH) or an arachnoid cyst. Most patients (85%) had a VP shunt at the time of sensor implantation.

Results

In total, 32 sensors were inserted in the 20 patients; the cause of re-implantation was technical malfunction of the implant. One sensor was explanted due to wound infection and one due to skin erosion. We experienced no complications directly related to the implantation/explantation procedures. A total of 149 recording sessions were conducted, including 68 home monitoring sessions. The median implantation period was 523 days with a median duration of clinical use at 202 days. The most likely consequence of a recording session was non-surgical treatment alteration (shunt valve adjustment or acetazolamide dose adjustment).

Conclusion

Telemetric ICP monitoring in children is safe and potentially decreases the number of invasive procedures. We find that telemetric ICP monitoring aids the clinical management of patients with complex CSF disorders and improves everyday life for both patient and parents. It allows continuous ICP measurement in the patient’s home and thereby potentially reducing hospitalisations, leading to significant cost savings.

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Abbreviations

ICP:

Intracranial pressure

CSF:

Cerebrospinal fluid

Acetazolamide:

Carbonic anhydrase inhibitor, sales name: Diamox

IIH:

Idiopathic intracranial hypertension

MRI:

Magnetic resonance imaging

ETV:

Endoscopic third ventriculostomy

MOH:

Medication overuse headache

BMI:

Body mass index

LPO:

Lumbar puncture opening pressure

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Authors and Affiliations

  1. Department of Neurosurgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Sarah Hornshøj Pedersen, Nicolas Hernandez Norager, Alexander Lilja-Cyron & Marianne Juhler

  2. Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark

    Sarah Hornshøj Pedersen & Marianne Juhler

Authors
  1. Sarah Hornshøj Pedersen
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  2. Nicolas Hernandez Norager
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Correspondence to Sarah Hornshøj Pedersen.

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Pedersen, S.H., Norager, N.H., Lilja-Cyron, A. et al. Telemetric intracranial pressure monitoring in children. Childs Nerv Syst 36, 49–58 (2020). https://doi.org/10.1007/s00381-019-04271-4

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