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ICP during head movement: significance of the venous system

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Abstract

Background

It is thought that the internal jugular veins (IJV) are the primary route for cranial venous outflow in supine position and the vertebral venous plexus when upright. Previous studies have noted a greater increase in intracranial pressure (ICP) when subjects turn their head in one direction compared to the other, but no clear cause had been investigated. We hypothesised that in the supine position, head turning and consequently obstructing the IJV draining the dominant transverse sinus (TVS) would lead to a greater rise in ICP compared to turning to the non-dominant side.

Methods

A prospective study in a large-volume neurosurgical centre. Patients undergoing continuous ICP monitoring as part of their standard clinical management were recruited. Immediate ICP was measured in different head positions (neutral, rotated to the right and left) when supine, seated, and standing. TVS dominance was established by consultant radiologist report on venous imaging.

Results

Twenty patients were included in the study, with a median age of 44 years. Venous system measurements revealed 85% right-sided vs 15% left-sided dominance. Immediate ICP rose more when head turning from neutral to the dominant TVS (21.93mmHg ± 4.39) vs non-dominant side (16.66mmHg ± 2.71) (p= <0.0001). There was no significant relationship in the sitting (6.08mmHg ± 3.86 vs 4.79mmHg ± 3.81, p = 0.13) or standing positions (8.74mmHg ± 4.30 vs 6.76mmHg ± 4.14, p =0.07).

Conclusion

This study has provided further evidence that the transverse venous sinus to internal jugular system pathway is the likely primary venous drainage when supine; and quantified its effect when head turning on ICP. It may guide patient-specific nursing care and advice.

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Data availability

Not applicable.

Abbreviations

ICP:

intracranial pressure

CTV:

computed tomography venography

MRV:

magnetic resonance venography

IJV:

internal jugular vein

TVS:

transverse venous sinus

IIH:

Idiopathic intracranial hypertension

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK

    Sogha Khawari, Alaa Al-Mohammad, Anand Pandit, Matthew James Bancroft, Kanza Tariq, Laurence Watkins & Ahmed Toma

  2. UCL Queen Square Institute of Neurology, London, UK

    Eleanor Moncur & Matthew James Bancroft

  3. Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK

    Peter Cowley

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  1. Sogha Khawari
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Correspondence to Sogha Khawari.

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Khawari, S., Al-Mohammad, A., Pandit, A. et al. ICP during head movement: significance of the venous system. Acta Neurochir 165, 3243–3247 (2023). https://doi.org/10.1007/s00701-023-05620-8

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