Intracranial Pressure Following Surgery of an Unruptured Intracranial Aneurysm-a Model for Normal Intracranial Pressure in Humans

Overview

Journal Fluids Barriers CNS

Publisher Biomed Central

Date 2024 May 22

PMID 38773608

Authors

Nicolas Hernandez Norager

Alexander Lilja-Cyron

Casper Schwartz Riedel

Anders Vedel Holst

Sarah Hornshoej Pedersen

Marianne Juhler

Affiliations

Soon will be listed here.

Abstract

Objective: Optimizing the treatment of several neurosurgical and neurological disorders relies on knowledge of the intracranial pressure (ICP). However, exploration of normal ICP and intracranial pressure pulse wave amplitude (PWA) values in healthy individuals poses ethical challenges, and thus the current documentation remains scarce. This study explores ICP and PWA values for healthy adults without intracranial pathology expected to influence ICP.

Methods: Adult patients (age > 18 years) undergoing surgery for an unruptured intracranial aneurysm without any other neurological co-morbidities were included. Patients had a telemetric ICP sensor inserted, and ICP was measured in four different positions: supine, lateral recumbent, standing upright, and 45-degree sitting, at day 1, 14, 30, and 90 following the surgery.

Results: ICP in each position did not change with time after surgery. Median ICP was 6.7 mmHg and median PWA 2.1 mmHg in the supine position, while in the upright standing position median ICP was - 3.4 mmHg and median PWA was 1.9 mmHg. After standardization of the measurements from the transducer site to the external acoustic meatus, the median ICP was 8.3 mmHg in the supine position and 1.2 mmHg in the upright standing position.

Conclusion: Our study provides insights into normal ICP dynamics in healthy adults following a uncomplicated surgery for an unruptured aneurysm. These results suggest a slightly wider normal reference range for invasive intracranial pressure than previously suggested, and present the first normal values for PWA in different positions. Further studies are, however, essential to enhance our understanding of normal ICP. Trial registration The study was preregistered at www.

Clinicaltrials: gov (NCT03594136) (11 July 2018).

References

Lenfeldt N, Koskinen L, Bergenheim A, Malm J, Eklund A . CSF pressure assessed by lumbar puncture agrees with intracranial pressure. Neurology. 2007; 68(2):155-8. DOI: 10.1212/01.wnl.0000250270.54587.71. View

Eide P, Sorteberg W . Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds. Neurol Res. 2007; 29(8):798-802. DOI: 10.1179/016164107X224132. View

Raboel P, Bartek Jr J, Andresen M, Bellander B, Romner B . Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review. Crit Care Res Pract. 2012; 2012:950393. PMC: 3376474. DOI: 10.1155/2012/950393. View

Chapman P, Cosman E, Arnold M . The relationship between ventricular fluid pressure and body position in normal subjects and subjects with shunts: a telemetric study. Neurosurgery. 1990; 26(2):181-9. DOI: 10.1097/00006123-199002000-00001. View

Eide P, Brean A . Lumbar cerebrospinal fluid pressure waves versus intracranial pressure waves in idiopathic normal pressure hydrocephalus. Br J Neurosurg. 2007; 20(6):407-14. DOI: 10.1080/02688690601047312. View

Hansen A, Lawley J, Rickards C, Howden E, Sarma S, Cornwell 3rd W . Reducing intracranial pressure by reducing central venous pressure: assessment of potential countermeasures to spaceflight-associated neuro-ocular syndrome. J Appl Physiol (1985). 2020; 130(2):283-289. DOI: 10.1152/japplphysiol.00786.2020. View

Lilja A, Andresen M, Hadi A, Christoffersen D, Juhler M . Clinical experience with telemetric intracranial pressure monitoring in a Danish neurosurgical center. Clin Neurol Neurosurg. 2014; 120:36-40. DOI: 10.1016/j.clineuro.2014.02.010. View

Malm J, Jacobsson J, Birgander R, Eklund A . Reference values for CSF outflow resistance and intracranial pressure in healthy elderly. Neurology. 2011; 76(10):903-9. DOI: 10.1212/WNL.0b013e31820f2dd0. View

Pedersen S, Andresen M, Lilja-Cyron A, Petersen L, Juhler M . Lumbar puncture position influences intracranial pressure. Acta Neurochir (Wien). 2021; 163(7):1997-2004. DOI: 10.1007/s00701-021-04813-3. View

10.

Miller J, Garibi J, Pickard J . A clinical study of intracranial volume pressure relationships. Br J Surg. 1973; 60(4):316. View

11.

Ekstedt J . CSF hydrodynamic studies in man. 2 . Normal hydrodynamic variables related to CSF pressure and flow. J Neurol Neurosurg Psychiatry. 1978; 41(4):345-53. PMC: 493028. DOI: 10.1136/jnnp.41.4.345. View

12.

Williams A, Coyne S . Effects of neck position on intracranial pressure. Am J Crit Care. 1993; 2(1):68-71. View

13.

Whiteley W, Al-Shahi R, Warlow C, Zeidler M, Lueck C . CSF opening pressure: reference interval and the effect of body mass index. Neurology. 2006; 67(9):1690-1. DOI: 10.1212/01.wnl.0000242704.60275.e9. View

14.

Saehle T, Eide P . Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients. J Neurosurg. 2015; 122(5):1076-86. DOI: 10.3171/2014.12.JNS141029. View

15.

Petersen L, Lawley J, Lilja-Cyron A, Petersen J, Howden E, Sarma S . Lower body negative pressure to safely reduce intracranial pressure. J Physiol. 2018; 597(1):237-248. PMC: 6312426. DOI: 10.1113/JP276557. View

16.

Warden K, Alizai A, Trobe J, Hoff J . Short-term continuous intraparenchymal intracranial pressure monitoring in presumed idiopathic intracranial hypertension. J Neuroophthalmol. 2011; 31(3):202-5. DOI: 10.1097/WNO.0b013e3182183c8d. View

17.

Schuhmann M, Sood S, McAllister J, Jaeger M, Ham S, Czosnyka Z . Value of overnight monitoring of intracranial pressure in hydrocephalic children. Pediatr Neurosurg. 2008; 44(4):269-79. DOI: 10.1159/000131675. View

18.

Gisolf J, van Lieshout J, van Heusden K, Pott F, Stok W, Karemaker J . Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol. 2004; 560(Pt 1):317-27. PMC: 1665206. DOI: 10.1113/jphysiol.2004.070409. View

19.

Farahmand D, Qvarlander S, Malm J, Wikkelso C, Eklund A, Tisell M . Intracranial pressure in hydrocephalus: impact of shunt adjustments and body positions. J Neurol Neurosurg Psychiatry. 2014; 86(2):222-8. DOI: 10.1136/jnnp-2014-307873. View

20.

Qvarlander S, Sundstrom N, Malm J, Eklund A . Postural effects on intracranial pressure: modeling and clinical evaluation. J Appl Physiol (1985). 2013; 115(10):1474-80. DOI: 10.1152/japplphysiol.00711.2013. View