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Telemetric intracranial pressure monitoring in children

Abstract

Purpose

Repeated intracranial pressure (ICP) measurements are essential in treatment of patients with complex cerebrospinal fluid (CSF) disorders. These patients often have a long surgical history with numerous invasive lumbar or intracranial pressure monitoring sessions and/or ventriculoperitoneal (VP) shunt revisions. Telemetric ICP monitoring might be an advantageous tool in treatment of these patients. In this paper, we evaluate our experience with this technology in paediatric patients.

Methods

During a 4-year period, we implanted telemetric ICP sensors (Raumedic NEUROVENT-P-tel) in 20 paediatric patients to minimise the number of future invasive procedures. Patients were diagnosed with hydrocephalus, idiopathic intracranial hypertension (IIH) or an arachnoid cyst. Most patients (85%) had a VP shunt at the time of sensor implantation.

Results

In total, 32 sensors were inserted in the 20 patients; the cause of re-implantation was technical malfunction of the implant. One sensor was explanted due to wound infection and one due to skin erosion. We experienced no complications directly related to the implantation/explantation procedures. A total of 149 recording sessions were conducted, including 68 home monitoring sessions. The median implantation period was 523 days with a median duration of clinical use at 202 days. The most likely consequence of a recording session was non-surgical treatment alteration (shunt valve adjustment or acetazolamide dose adjustment).

Conclusion

Telemetric ICP monitoring in children is safe and potentially decreases the number of invasive procedures. We find that telemetric ICP monitoring aids the clinical management of patients with complex CSF disorders and improves everyday life for both patient and parents. It allows continuous ICP measurement in the patient’s home and thereby potentially reducing hospitalisations, leading to significant cost savings.

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Abbreviations

ICP:

Intracranial pressure

CSF:

Cerebrospinal fluid

Acetazolamide:

Carbonic anhydrase inhibitor, sales name: Diamox

IIH:

Idiopathic intracranial hypertension

MRI:

Magnetic resonance imaging

ETV:

Endoscopic third ventriculostomy

MOH:

Medication overuse headache

BMI:

Body mass index

LPO:

Lumbar puncture opening pressure

References

  1. Lilja A, Andresen M, Hadi A, Christoffersen D, Juhler M (2014) Clinical experience with telemetric intracranial pressure monitoring in a Danish neurosurgical center. Clin Neurol Neurosurg 120:36–40. https://doi.org/10.1016/j.clineuro.2014.02.010

    Article  PubMed  Google Scholar 

  2. Norager NH, Lilja-Cyron A, Bjarkam CR, Duus S, Juhler M (2018) Telemetry in intracranial pressure monitoring: sensor survival and drift. Acta Neurochir 1:1–8. https://doi.org/10.1007/s00701-018-3691-9

    Article  Google Scholar 

  3. Lilja-Cyron A, Kelsen J, Andresen M, Fugleholm K, Juhler M (2018) Feasibility of telemetric intracranial pressure monitoring in the neuro intensive care unit. J Neurotrauma 35:1578–1586. https://doi.org/10.1089/neu.2017.5589

    Article  PubMed  Google Scholar 

  4. Antes S, Tschan CA, Oertel JM (2014) An operative technique combining endoscopic third ventriculostomy and long-term ICP monitoring. Childs Nerv Syst 30:331–335. https://doi.org/10.1007/s00381-013-2269-3

    Article  PubMed  Google Scholar 

  5. Schmitt M, Kiefer M, Antes S, Eymann R (2012) Detection of hidden pseudotumour cerebri behind Chiari 1 malformation: value of telemetric ICP monitoring. Childs Nerv Syst 28:1811–1813. https://doi.org/10.1007/s00381-012-1749-1

    Article  PubMed  Google Scholar 

  6. Kiefer M, Antes S, Schmitt M et al (2011) Long-term performance of a CE-approved telemetric intracranial pressure monitoring. Conf Proc IEEE Eng Med Biol Soc:2246–2249. https://doi.org/10.1109/IEMBS.2011.6090426

  7. Beez T, Kane ÃRO, Piper ÃI et al (2016) Telemetric intracranial pressure monitoring in syndromic craniosynostosis. J Craniofac Surg 27:1032–1034. https://doi.org/10.1097/SCS.0000000000002556

    Article  PubMed  Google Scholar 

  8. Magnéli S, Howells T, Saiepour D, Nowinski D, Enblad P, Nilsson P (2016) Telemetric intracranial pressure monitoring : a noninvasive method to follow up children with complex craniosynostoses. A case report. Childs Nerv Syst 32:1311–1315. https://doi.org/10.1007/s00381-016-3023-4

    Article  PubMed  Google Scholar 

  9. Antes S, Tschan CA, Heckelmann M, Breuskin D, Oertel J (2016) Telemetric intracranial pressure monitoring with the Raumedic Neurovent P-tel. World Neurosurg 91:133–148. https://doi.org/10.1016/j.wneu.2016.03.096

    Article  PubMed  Google Scholar 

  10. Antes S, Tschan CA, Kunze G, Ewert L, Zimmer A, Halfmann A, Oertel J (2014) Clinical and radiological findings in long-term intracranial pressure monitoring. Acta Neurochir 156:1009–1019. https://doi.org/10.1007/s00701-013-1991-7

    Article  PubMed  Google Scholar 

  11. Kasotakis G, Michailidou M, Bramos A, Chang Y, Velmahos G, Alam H, King D, de Moya MA (2012) Intraparenchymal vs extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more? J Am Coll Surg 214:950–957. https://doi.org/10.1016/j.jamcollsurg.2012.03.004

    Article  PubMed  Google Scholar 

  12. Dimitriou J, Levivier M, Gugliotta M (2016) Comparison of complications in patients receiving different types of intracranial pressure monitoring: a retrospective study in a single center in Switzerland. World Neurosurg 89:641–646. https://doi.org/10.1016/j.wneu.2015.11.037

    Article  PubMed  Google Scholar 

  13. Ma R, Rowland D, Judge A, Calisto A, Jayamohan J, Johnson D, Richards P, Magdum S, Wall S (2018) Complications following intracranial pressure monitoring in children: a 6-year single-center experience. J Neurosurg Pediatr 21:278–283. https://doi.org/10.3171/2017.9.PEDS17360

    Article  PubMed  Google Scholar 

  14. Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, Webster JG (2017) Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas 38:R143–R182. https://doi.org/10.1088/1361-6579/aa7256

    Article  PubMed  Google Scholar 

  15. Antes S, Stadie A, Müller S, Linsler S, Breuskin D, Oertel J (2018) Intracranial pressure–guided shunt valve adjustments with the Miethke sensor reservoir. World Neurosurg 109:e642–e650. https://doi.org/10.1016/j.wneu.2017.10.044

    Article  PubMed  Google Scholar 

  16. Freimann FB, Schulz M, Haberl H, Thomale UW (2014) Feasibility of telemetric ICP-guided valve adjustments for complex shunt therapy. Childs Nerv Syst 30:689–697. https://doi.org/10.1007/s00381-013-2324-0

    Article  PubMed  Google Scholar 

  17. Barber JM, Pringle CJ, Raffalli-ebezant H et al (2016) Telemetric intra-cranial pressure monitoring : clinical and financial considerations. Br J Neurosurg 31:300–306. https://doi.org/10.1080/02688697.2016.1229752

    Article  PubMed  Google Scholar 

  18. Andresen M, Juhler M (2014) Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans. J Neurosurg 121:1–5. https://doi.org/10.3171/2014.2.JNS132209

    Article  Google Scholar 

  19. Willer L, Jensen RH, Juhler M (2010) Medication overuse as a cause of chronic headache in shunted hydrocephalus patients. J Neurol Neurosurg Psychiatry 81:1261–1264. https://doi.org/10.1136/jnnp.2009.198101

    CAS  Article  PubMed  Google Scholar 

  20. Xu DS, Hlubek RJ, Mulholland CB, Knievel KL, Smith KA, Nakaji P (2017) Use of intracranial pressure monitoring frequently refutes diagnosis of idiopathic intracranial hypertension. World Neurosurg 104:167–170. https://doi.org/10.1016/j.wneu.2017.04.080

    Article  PubMed  Google Scholar 

  21. Yu L, Kim BJ, Meng E (2014) Chronically implanted pressure sensors: challenges and state of the field. Sensors (Switzerland) 14:20620–20644. https://doi.org/10.3390/s141120620

    Article  Google Scholar 

  22. Jiang G (2010) Design challenges of implantable pressure monitoring system. Front Neurosci 4:2–5. https://doi.org/10.3389/neuro.20.002.2010

    Article  PubMed Central  Google Scholar 

  23. Du ZJ, Kolarcik CL, Kozai TDY et al (2017) Ultrasoft microwire neural electrodes improve chronic tissue integration. Acta Biomater 53:46–58. https://doi.org/10.1016/j.actbio.2017.02.010

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Sarah Hornshøj Pedersen.

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Pedersen, S.H., Norager, N.H., Lilja-Cyron, A. et al. Telemetric intracranial pressure monitoring in children. Childs Nerv Syst 36, 49–58 (2020). https://doi.org/10.1007/s00381-019-04271-4

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  • DOI: https://doi.org/10.1007/s00381-019-04271-4

Keywords

  • Telemetric; telemetry
  • Children; paediatric
  • ICP; intracranial pressure
  • Hydrocephalus
  • IIH; idiopathic intracranial hypertension
  • Raumedic