Continuous Intracranial Pressure Monitoring in Children with 'Benign' External Hydrocephalus

Abstract

External hydrocephalus; Intracranial hypertension; Intracranial pressure monitoring

Hidrocefalia externa; Hipertensión intracraneal; Monitorización de la presión intracraneal

Hidrocefàlia externa; Hipertensió intracranial; Monitorització de la pressió intracranial

Background/Objectives: This study aimed to evaluate the results of continuous intracranial pressure (ICP) monitoring in children with macrocephaly or rapidly increasing head circumference (HC) diagnosed as benign external hydrocephalus (BEH). Here, we report the absolute ICP measurements, ICP pulsatility, and slow ICP waves after at least 48 h of continuous monitoring in a cohort of 36 children diagnosed with BEH. Methods: A prospective study of continuous ICP monitoring was performed in 36 consecutive children with macrocephaly (HC above the 97.5th percentile) or rapidly increasing HC (at least crossing two percentile curves), diagnosed with BEH (22 boys and 14 girls with a mean age of 23.6 ± 13.3 months, minimum: 6, maximum 65), using an epidural sensor. For the first four children in the study, hard copies of the ICP values were obtained using an analog recorder. Starting from the fifth patient, the ICP signal was sampled at 200 Hz and stored on a computer using a computer-based data acquisition and analysis system (LabChart v8.1 software). Results: Clinical signs or symptoms were identified in 20 patients (55.6%). Delayed motor or language development was noted in 18 (50%) and 20 (55.6%) patients, respectively. In 13 patients, the enlargement of the subarachnoid spaces was found to be associated with an additional condition. The median of mean ICP values for the entire cohort was 17 mmHg, with a minimum of 6.7 mmHg and a maximum of 29 mmHg. All patients exhibited a percentage of B waves exceeding 20% during the night, with a median value of 47.4% (min: 23.2, max: 75). Three children had nocturnal plateau waves. At night, regular ICP recordings alternated with periods of significant increases in ICP, often exceeding 10 mmHg above baseline values. High-amplitude B waves were noted during these episodes, and the amplitude of the cardiac waveform at the peak of the B waves was consistently greater than 5 mmHg, displaying an abnormal morphology (P2 > P1). A ventriculoperitoneal shunt was implanted in 30 of the 36 patients. Conclusions: Patients with BEH may present significant abnormalities in ICP. Monitoring this variable in certain cases can assist in determining the necessity for surgical treatment.

This study was partially funded by Instituto de Salud Carlos III (ISCIII) through projects PI18/00468 and PI22/01082, co-funded by the European Union and awarded to M.A. Poca, by the SafeICP project (Ref: PLEC2022-009290) funded by MCIN/AEI/10.13039/501100011033 and European Union Next Generation EU/PRTR, and by grant 2021SGR/00810 from the Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Departament de Recerca i Universitats de la Generalitat de Catalunya, Spain.