Clinical Significance of ICP Measurement in Infants Part II: Intracranial Pressure in Infants with Hydrocephalus

Abstract

Despite the advantage of intracranial pressure (ICP) measurement in infants, many surgeons are still reluctant to use it because of possible operative complications. Abnormal ICPs in hydrocephalic infants have often been reported, where pressure waves, observed particularly in REM sleep, seem to be a pathological phenomenon due to the decrease in ability for spatial compensation (Chawla et al. 1974). Furthermore, one of the problems in evaluating ICP data in infants is uncertainty in the definition of true normal ICP, which changes simultaneously with the natural development of infants (Welch 1980). In part I of this study, the authors tried to delineate the characteristics of normal ICP in infants. In reviewing ICP measurements in 32 normal infants, pressure waves similar to the A and B waves first described by Lundberg (1960) were found, particularly in REM sleep. It was also noted that increase in amplitude was directly proportional to increase in age. In this study, our concern is to evaluate one of the current adjunctive procedures in pediatric neurosurgery, continuous intracranial pressure monitoring of patients with hydrocephalus, and to evaluate its efficacy as a factor to be taken into account when making decisions on treatments. Although several papers on hydrocephalus and ICP have been published (Symon et al. 1972; Symon and Dorsch 1975; Di Rocco et al. 1975; Di Rocco et al. 1976; Pierre-Kahn et al. 1976; Venes 1979), the problem of the way ICP changes in these patients and the kinds of spontaneous fluctuation that can be expected still remains.