Is intracranial pressure waveform analysis useful in the management of pediatric neurosurgical patients?

Background: We have reported casuistic observations that intracranial pressure (ICP) waveform analysis may be useful in the management of pediatric patients.

Method: We here report our whole patient material of 65 children undergoing ICP monitoring with storage of their ICP raw data files during the years 2002-2005. We retrospectively explored the clinical symptoms/findings and radiological cerebral ventricular size before ICP monitoring. Mean ICP was the actively treated ICP parameter. Using an algorithm for identification of cardiac-beat-induced pressure waves we retrospectively determined the mean ICP wave amplitude and latency, in addition to mean ICP. Outcome with regard to change in symptoms/findings during a 1-year period was determined in 55 children.

Results: The material includes children with hydrocephalus, craniosynostosis, shunt failure, benign intracranial hypertension and others. The ICP recordings gave wrong diagnostic information due to bad signal quality in 5 of 65 patients (7.7%). The mean ICP wave amplitude was increased in those with papilledema, lethargy and nausea. The main observations were that the mean ICP wave amplitude (not mean ICP) was increased in those that improved from clinical symptoms/findings after treatment and in those that were unchanged/worse after not being treated.

Conclusions: Waveform analysis with computation of the mean ICP wave amplitude was more useful by providing information about the quality of the ICP recording, by comparing better with the symptoms/findings at the time of ICP monitoring and by best predicting outcome. Most significantly, 14 of 55 patients (25%) with high amplitudes and left untreated did not recover spontaneously.