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Saeed A, Boulton R, O'Kane R, Shaw M, Moss L. A clinical evaluation of variation in paediatric intracranial pressure waveforms. BRAIN & SPINE 2024; 4:102859. [PMID: 39105102 PMCID: PMC11298851 DOI: 10.1016/j.bas.2024.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 05/16/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024]
Abstract
Introduction Intracranial pressure (ICP) monitoring is commonly used in investigating the aetiology of chronic paediatric neurological conditions. A series of high-amplitude spikes has been observed in overnight ICP recordings of some children, many of whom have hydrocephalus or craniosynostosis. Research question This clinical evaluation aimed to define the spike pattern, describe the patient group in which it is most likely to occur, and conduct high-resolution waveform analysis. Material and methods ICP waveforms from 40 patients aged 0-5 years (inclusive), recorded between 2017 and 2021 at the Royal Hospital for Children Glasgow, were retrospectively analysed. The pattern was defined through visual inspection of regions of interest by two reviewers. Patients were stratified using demographic and clinical data. R software was used to perform regression and high-resolution waveform analyses. Results The spike pattern was defined as the presence of 2 consecutive spikes with an amplitude of at least 8 mmHg, with a gap of at least 30 min between spikes. In the adjusted Poisson regression, age was significantly associated with the number of spikes (IRR 0.8, 95% CI 0.70 to 0.92, p-value 0.001). Discussion and conclusion Younger age was significantly associated with an increased number of spikes in this cohort. Investigation of clinical consequences of the spikes is warranted.
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Affiliation(s)
- Amarah Saeed
- School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Richard Boulton
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Roddy O'Kane
- Royal Hospital for Children & Institute of Neurological Sciences, 1345 Govan Road, Glasgow, Scotland, United Kingdom
| | - Martin Shaw
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Laura Moss
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
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3
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Mitchell JL, Buckham R, Lyons H, Walker JK, Yiangou A, Sassani M, Thaller M, Grech O, Alimajstorovic Z, Julher M, Tsermoulas G, Brock K, Mollan SP, Sinclair AJ. Evaluation of diurnal and postural intracranial pressure employing telemetric monitoring in idiopathic intracranial hypertension. Fluids Barriers CNS 2022; 19:85. [PMID: 36320018 PMCID: PMC9628104 DOI: 10.1186/s12987-022-00384-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Intracranial pressure (ICP) has been thought to vary diurnally. This study evaluates diurnal ICP measurements and quantifies changes in ICP occurring with changes in body posture in active idiopathic intracranial hypertension (IIH). METHODS This prospective observational study utilized telemetric ICP monitoring in people with active IIH. Participants had the Raumedic p-Tel ICP intraparenchymal device (Raumedic, Hembrechts, Germany) surgically inserted. Changes in ICP in the supine position were evaluated. Then, the ICP was measured in the standing, sitting, supine, left lateral decubitus positions and with coughing and bending. Ultimately, changes in ICP over the course of 24 h were recorded. ISRCTN registration number 12678718. RESULTS 15 women were included, mean (standard deviation) age 29.5 (9.5) years, body mass index 38.1 (6.2) kg/m2, and baseline mean ICP of 21.2 (4.8) mmHg (equivalent to 28.8 (6.5) cmCSF). Mean ICP rose with the duration in the supine position 1.2 (3.3) mmHg over 5-minutes (p = 0.175), 3.5 (2.8) mmHg over 30-minutes (p = 0.0002) and by a further 2.1 (2.2) mmHg over 3 h (p = 0.042). Mean ICP decreased by 51% when moving from the supine position to standing (21.2 (4.8) mmHg to 10.3 (3.7) mmHg respectively, p = 0.0001). Mean ICP increased by 13% moving from supine to the left lateral decubitus position (21.2 (4.8) mmHg to 24.0 (3.8) mmHg, p = 0.028). There was no significant difference in ICP measurements at any point during the daytime, or between 5-minute standing or supine recordings and prolonged ambulatory daytime and end of night supine recordings respectively. ICP, following an initial drop, increased progressively in conjunction with lying supine position from 23:00 h to 07:00 h by 34% (5.2 (1.9) mmHg, p = 0.026). CONCLUSION This analysis demonstrated that ICP does not appear to have a diurnal variation in IIH, but varies by position and duration in the supine position. ICP rose at night whilst the patient was continuously supine. Furthermore, brief standing and supine ICP measures in the day predicted daytime prolonged ambulatory measures and end of night peak ICP respectively. This knowledge gives reassurance that ICP can be accurately measured and compared at any time of day in an ambulant IIH patient. These are useful findings to inform clinical measurements and in the interpretation of ICP analyses in IIH. TRIAL REGISTRATION ISTCRN (12678718).
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Affiliation(s)
- James L Mitchell
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK ,Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, LE12 5BL Loughborough, UK
| | - Rebecca Buckham
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK
| | - Hannah Lyons
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
| | - Jessica K Walker
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK
| | - Andreas Yiangou
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
| | - Matilde Sassani
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
| | - Mark Thaller
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
| | - Olivia Grech
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK
| | - Zerin Alimajstorovic
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK
| | - Marianne Julher
- grid.475435.4Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Georgios Tsermoulas
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham, Birmingham, UK
| | - Kristian Brock
- grid.6572.60000 0004 1936 7486Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Susan P Mollan
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XBirmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
| | - Alexandra J Sinclair
- grid.6572.60000 0004 1936 7486Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, B15 2TT Birmingham, UK ,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, B15 2TH Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, B15 2WB Birmingham, UK
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4
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Miyabayashi H, Nagano N, Hashimoto S, Saito K, Kato R, Noto T, Sasano M, Sumi K, Yoshino A, Morioka I. Evaluating Cranial Growth in Japanese Infants Using a Three-dimensional Scanner: Relationship between Growth-related Parameters and Deformational Plagiocephaly. Neurol Med Chir (Tokyo) 2022; 62:521-529. [PMID: 36184476 DOI: 10.2176/jns-nmc.2022-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study, we aimed to evaluate the longitudinal changes in the cranial shape of healthy Japanese infants using a three-dimensional scanner and construct a normal values database for the growth process. Preterm infants (gestational age < 37 weeks), infants with neonatal asphyxia (5-minute Apgar score of <7), and patients who started helmet therapy for deformational plagiocephaly were excluded from this study. The first scan was performed at approximately 1 month of age, followed by two scans conducted at 3 and 6 months of age. The parameters considered were as follows: cranial length, width, height, circumference, volume, cranial vault asymmetry index, and cephalic index. A cranial vault asymmetry index >5% was defined as deformational plagiocephaly. Changes in each parameter were examined using repeated-measures analysis of variance classified by sex and deformational plagiocephaly status. The rate of increase in each parameter was also examined. In total, 88 infants (45 boys and 43 girls) were included in this study. All growth-related parameters were noted to increase linearly with time. Sex differences were observed in all parameters except cranial length. Deformational plagiocephaly was found to have no effect on growth-related parameters. Cranial volume increased by 60% from 1 to 6 months of age. The growth almost uniformly influenced the rate of increase in volume in each coordinate axis direction. Overall, the mean trends in three-dimensional parameters in infants up to 6 months of age were obtained using a three-dimensional scanner. These trends could be used as a guide by medical professionals involved in cranioplasty.
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Affiliation(s)
- Hiroshi Miyabayashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine.,Department of Pediatrics, Kasukabe Medical Center
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | | | | | - Risa Kato
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Takanori Noto
- Department of Pediatrics and Child Health, Nihon University School of Medicine.,Noto Children's Clinic
| | - Mari Sasano
- Department of Neurological Surgery, Nihon University School of Medicine
| | - Koichiro Sumi
- Department of Neurological Surgery, Nihon University School of Medicine
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine
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5
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Chong PLH, Garic D, Shen MD, Lundgaard I, Schwichtenberg AJ. Sleep, cerebrospinal fluid, and the glymphatic system: A systematic review. Sleep Med Rev 2022; 61:101572. [PMID: 34902819 PMCID: PMC8821419 DOI: 10.1016/j.smrv.2021.101572] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
Current theories of the glymphatic system (GS) hypothesize that it relies on cerebrospinal fluid (CSF) circulation to disseminate growth factors and remove metabolic waste from the brain with increased CSF production and circulation during sleep; thereby, linking sleep disturbance with elements of CSF circulation and GS exchange. However, our growing knowledge of the relations between sleep, CSF, and the GS are plagued by variability in sleep and CSF measures across a wide array of pathologies. Hence, this review aims to summarize the dynamic relationships between sleep, CSF-, and GS-related features in samples of typically developing individuals and those with autoimmune/inflammatory, neurodegenerative, neurodevelopmental, sleep-related, neurotraumatic, neuropsychiatric, and skull atypicalities. One hundred and ninety articles (total n = 19,129 participants) were identified and reviewed for pathology, CSF circulation and related metrics, GS function, and sleep. Numerous associations were documented between sleep problems and CSF metabolite concentrations (e.g., amyloid-beta, orexin, tau proteins) and increased CSF volumes or pressure. However, these relations were not universal, with marked differences across pathologies. It is clear that elements of CSF circulation/composition and GS exchange represent pathways influenced by sleep; however, carefully designed studies and advances in GS measurement are needed to delineate the nuanced relationships.
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Affiliation(s)
| | - D. Garic
- University of North Carolina, Chapel Hill, NC
| | - M. D. Shen
- University of North Carolina, Chapel Hill, NC
| | - I. Lundgaard
- Department of Experimental Medicine Science, Lund University, Lund, Sweden,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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Bansal S, Konar S, Shukla D, Srinivas D, Pandey V, Jayan M, Sadashiva N, Devi BI. Intraoperative Measurement of Intracranial Pressure During Cranial Vault Remodeling in Children with Craniosynostosis. J Neurosci Rural Pract 2022; 13:80-86. [PMID: 35110924 PMCID: PMC8803524 DOI: 10.1055/s-0041-1741564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose
In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS).
Methods
This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure.
Results
A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The ICP recordings helped in undoing the height reduction in two children and ventriculoperitoneal shunt after surgery in two children.
Conclusions
Intraoperative monitoring of ICP helps in deciding the type of cranial vault remodeling and the need for CSF diversion after surgery.
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Affiliation(s)
- Sonia Bansal
- Department of Neuroanesthesiology and Critical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vishram Pandey
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mini Jayan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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8
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Norager NH, Olsen MH, Pedersen SH, Riedel CS, Czosnyka M, Juhler M. Reference values for intracranial pressure and lumbar cerebrospinal fluid pressure: a systematic review. Fluids Barriers CNS 2021; 18:19. [PMID: 33849603 PMCID: PMC8045192 DOI: 10.1186/s12987-021-00253-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values. METHOD A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals. RESULTS Thirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were - 5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. CONCLUSIONS This systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter.
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Affiliation(s)
| | | | | | - Casper Schwartz Riedel
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Marek Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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