Short-Term Continuous Intraparenchymal Intracranial Pressure Monitoring in Presumed Idiopathic Intracranial Hypertension
Short-Term Continuous Intraparenchymal Intracranial Pressure Monitoring in Presumed Idiopathic Intracranial Hypertension
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DOI：
10.1097/wno.0b013e3182183c8d
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发表时间：
2011-09-01
影响因子：
2.9
通讯作者：
Hoff, Julian T.
中科院分区：
文献类型：
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作者：
Warden, Kara F.;Alizai, Adeela M.;Hoff, Julian T.
背景资料：特发性颅内高压（IIH）的管理取决于对颅内压（ICP）的可靠评估，特别是当视觉功能测量或检眼镜指标令人困惑时，以及考虑进行侵入性外科手术时。虽然ICP监测已被广泛应用于许多神经系统疾病，作为一种比腰椎穿刺（LP）更可靠的持续ICP测量方法，但它并不常被广泛用于IIH的管理。我们检索了密歇根大学2001年至2008年期间的记录，寻找使用脑实质内Codman ICP监测系统进行LP和连续ICP监测的IIH患者，至少有1年的随访信息。结果：ICP监测无并发症发生。ICP监测影响了所有10例患者的管理。在8例患者中，LP显示开放压升高;其中7例，ICP监测未能证实持续高ICP。在这些患者中，决定停用ICP降低剂或分流器，或不修改留置分流器，在至少1年的随访期内，视觉功能或视盘外观没有变化。在1例患者中，ICP监测证实LP提示的高ICP，证明放置脑室腹膜分流术是合理的。在1例患者中，ICP监测，而不是LP，因为岩斜区的质量构成了危险的性能LP;分流，随后放置由于ICP升高。结论：在提供更准确的信息ICP比LP，短期连续ICP脑实质内监测可能是一个有用的辅助管理IIH时，临床数据是混乱和侵入性干预措施正在考虑中。
Background: The management of idiopathic intracranial hypertension (IIH) depends on a reliable assessment of intracranial pressure (ICP), particularly when visual function measures or ophthalmoscopic indicators are confusing and when invasive surgical procedures are being considered. Although ICP monitoring has been widely applied in many neurologic conditions as a more reliable measure of ongoing ICP than lumbar puncture (LP), it has not often been widely used in the management of IIH.Methods: We searched the records of the University of Michigan between 2001 and 2008 for patients with IIH who had undergone LP and continuous ICP monitoring with an intraparenchymal Codman ICP Monitoring System and in whom at least 1 year of follow-up information was available. Ten patients met entry criteria.Results: There were no complications from the ICP monitoring. ICP monitoring influenced management in all 10 patients. In 8 patients, LP had shown elevated opening pressures; in 7 of them, ICP monitoring failed to confirm a consistently high ICP. In these patients, the decision to withdraw ICP-lowering agents or shunts, or not to revise indwelling shunts, produced no change in visual function or optic disc appearance over a follow-up period of at least 1 year. In 1 patient, ICP monitoring confirmed the high ICP suggested by LP, justifying placement of a ventriculoperitoneal shunt. In 1 patient, ICP monitoring was performed instead of LP because a petroclival mass posed a danger to the performance of LP; a shunt was subsequently placed due to elevated ICP.Conclusion: In providing more accurate information about ICP than about LP, short-term continuous ICP intra-parenchymal monitoring may be a useful adjunct in the management of IIH when clinical data are confusing and invasive interventions are under consideration.