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Interpretation of telemetric intracranial pressure recordings in people with idiopathic intracranial hypertension after shunt implantation

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Abstract

Background

The M.scio telesensor (Aesculap-Miethke, Germany) is a device integrated within a ventriculoperitoneal (VP) shunt for non-invasive measurement of the intracranial pressure (ICP). The purpose of this study was to analyze the telemetric recordings with the M.scio system in shunted patients with idiopathic intracranial hypertension (IIH), in order to determine reference values and assist the interpretation of telemetric data.

Methods

This was a cohort study of consecutive patients with fulminant IIH who underwent primary VP shunt insertion between July 2019 and June 2022. The first telemetric measurements after surgery in the sitting and supine positions were analyzed. Telemetric ICP values, wave morphology, and pulse amplitude were determined for functioning and malfunctioning shunts.

Results

Fifty-seven out of 64 patients had available telemetric recordings. The mean ICP was − 3.8 mmHg (standard deviation (SD) = 5.9) in the sitting and 16.4 mmHg (SD = 6.3) in the supine position. The ICP curve demonstrated pulsatility in 49 (86%) patients. A pulsatile curve with mean ICP in the above ranges indicated a functioning shunt, whereas the lack of pulsatility was challenging to interpret. There was a significant positive correlation between ICP versus amplitude, ICP versus body mass index (BMI), and amplitude versus BMI.

Conclusions

This clinical study defined ICP values and curves in IIH patients with a shunt. The results will assist the interpretation of telemetric ICP recordings in clinical decision making. More research is required to model longitudinal recordings and explore the link between telemetric measurements with clinical outcomes.

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Data Availability

The data that support the findings of this study are not openly available due to confidentiality reasons and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at University Hospitals Birmingham NHS Foundation Trust.

Abbreviations

AMP:

Amplitude

BMI:

Body mass index

CSF:

Cerebrospinal fluid

IIH:

Idiopathic intracranial hypertension

ICP:

Intracranial pressure

SD:

Standard deviation

VP:

Ventriculoperitoneal

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, UK

    Fardad T. Afshari, Mahmoud Samara, Kyaw Zayar Thant, Marian E. Byrne & Georgios Tsermoulas

  2. Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

    Alexandra J. Sinclair, Susan P. Mollan & Georgios Tsermoulas

  3. Department of Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Alexandra J. Sinclair

  4. Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Susan P. Mollan

Authors
  1. Fardad T. Afshari
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  2. Mahmoud Samara
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  3. Kyaw Zayar Thant
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  4. Marian E. Byrne
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  5. Alexandra J. Sinclair
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  6. Susan P. Mollan
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  7. Georgios Tsermoulas
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Fardad Afshari, Mahmoud Samara, Kyaw Zayar Thant, Marian Byrne, and Georgios Tsermoulas. The first draft of the manuscript was written by Fardad Afshari and Georgios Tsermoulas, and it was reviewed and edited by Alexandra Sinclair and Susan Mollan. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Georgios Tsermoulas.

Ethics declarations

Ethical approval and consent to participate

All procedures performed in this study were in accordance with the ethical standards of University Hospitals Birmingham NHS Foundation Trust and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All data included in the cohort were obtained as part of routine clinical practice, and this study was approved as service evaluation (Clinical Audit Registration & Management System number: 18463). Ethics approval by a research ethics committee was not required. All data were anonymized for analysis so that individual patients could not be identified, and patient consent was not required.

Conflict of interest

Professor Mollan has received Honoria from Novartis for speaking on fundoscopy, but within a National headache network meeting (2019); Chiesi (2020, 2021), Heidelberg Engineering (2019, 2020, 2021), and Teva (2019, 2021). Professor Mollan has served on advisory boards for Invex Therapeutics, Janssen, and Roche. Professor Mollan has received payment for consultancy work for Invex therapeutics (2020, 2021). Professor Sinclair has received speaker fees and Honoraria from Novartis (erenumab) and Allergan (BOTOX), in addition, Invex therapeutics, a company director with salary and stock options (2019, 2020). Professor Sinclair is supported by a Sir Jules Thorn Award for Biomedical Research.

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Afshari, F.T., Samara, M., Thant, K.Z. et al. Interpretation of telemetric intracranial pressure recordings in people with idiopathic intracranial hypertension after shunt implantation. Acta Neurochir 165, 1523–1531 (2023). https://doi.org/10.1007/s00701-023-05572-z

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