Use of Intracranial Pressure Monitoring Frequently Refutes Diagnosis of Idiopathic Intracranial Hypertension
Use of Intracranial Pressure Monitoring Frequently Refutes Diagnosis of Idiopathic Intracranial Hypertension
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DOI：
10.1016/j.wneu.2017.04.080
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发表时间：
2017-08-01
影响因子：
2
通讯作者：
Nakaji, Peter
中科院分区：
文献类型：
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作者：
Xu, David S.;Hlubek, Randall J.;Nakaji, Peter
背景：特发性颅内高压（IIH）患者的诊断和治疗经常依赖腰椎穿刺来确定颅内压（ICP）。然而，由于患者的身体习惯和行为，以这种方式得出的ICP值可能是虚假的。我们最近将直接持续的ICP监测纳入了IIH的工作中。方法：通过账单记录，我们确定了3年内所有诊断为IIH并在分流器放置或翻修前接受ICP监测的患者。回顾了患者人口统计学和临床数据。结果：在30例采用肝实质内钢丝进行ICP监测的患者中，17例在过去6个月内进行了腰椎穿刺。腰椎穿刺结果显示所有17例患者开口压力升高，而只有2例患者（12%）在直接监测ICP时发现ICP持续升高。在接受分流评估的15例患者中，4例（27%）发现ICP升高。在15例已有分流管的患者中，2例（13%）患者在压力监测后发现分流管功能异常，3例（20%）患者发现不必要的分流管并予以移除。无患者出现有创监测并发症。结论：直接颅内压监测是确定颅内压的金标准，可安全有效地应用于IIH患者的随访和治疗，减少误诊和不必要手术的发生。
BACKGROUND: The diagnosis and management of patients with idiopathic intracranial hypertension (IIH) frequently relies on lumbar puncture to ascertain intracranial pressure (ICP). However, ICP values derived this way may be spurious owing to patient body habitus and behavior. We recently incorporated direct continuous ICP monitoring into the work-up for IIH. -METHODS: Through billing records, we identified all patients during a 3-year periodwho had a diagnosis of IIH and who underwent ICP monitoring before shunt placement or revision. Patient demographics and clinical data were reviewed.RESULTS: Of 30 patients who underwent ICP monitoring with an intraparenchymal wire, 17 had undergone lumbar puncture within the previous 6 months. Results from lumbar punctures showed an elevated opening pressure in all 17 patients, whereas only 2 patients (12%) were found to have consistently elevated ICP with direct ICP monitoring. Of 15 patients being evaluated for shunting, 4 (27%) were found to have elevated ICP. Of the 15 patients with existing shunts, 2 patients (13%) were found to havemalfunctioning shunts after pressure monitoring, and 3 patients (20%) had shunts that were found to be unnecessary and were removed. No patient experienced any complication from invasive monitoring.CONCLUSIONS: Direct ICP monitoring is the gold standard for determining ICP and can be safely and effectively applied to the work-up and treatment of patients with IIH to reduce the occurrence of misdiagnosis and unnecessary surgery.