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The initial intracranial pressure spike phenomenon

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Abstract

Background

Elective use of intraparenchymal intracranial pressure (ICP) monitoring is a valuable resource in the investigation of hydrocephalus and other cerebrospinal fluid disorders. Our preliminary study aims to investigate ICP changes in the immediate period following dural breach, which has not yet been reported on.

Method

This is a prospective cohort study of patients undergoing elective ICP monitoring, recruited between March and May 2022. ICP readings were obtained at opening and then at 5-min intervals for a 30-min duration.

Results

Ten patients were recruited, mean age 45 years, with indications of a Chiari malformation (n = 5), idiopathic intracranial hypertension (n = 3) or other ICP-related pathology (n = 2). Patients received intermittent bolus sedation (80%) vs general anaesthesia (20%). Mean opening pressure was 22.9 mmHg [± 6.0], with statistically significant decreases present every 5 min, to a total reduction of 15.2 mmHg at 20 min (p = < 0.0001), whereafter the ICP plateaued with no further statistical change.

Discussion

Our results highlight an intracranial opening pressure ‘spike’ phenomenon. This spike was 15.2 mmHg higher than the plateau, which is reached at 20 min after insertion. Several possible causes exist which require further research in larger cohorts, including sedation and pain response. Regardless of causation, this study provides key information on the use of ICP monitoring devices, guiding interpretation and when to obtain measurements.

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Authors and Affiliations

  1. University College London University, London, UK

    Francesco Magni

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

    Sogha Khawari, Anand Pandit, Eleanor M. Moncur, Laurence Watkins, Ahmed Toma & Lewis Thorne

Authors
  1. Francesco Magni
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  2. Sogha Khawari
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  3. Anand Pandit
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  4. Eleanor M. Moncur
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  5. Laurence Watkins
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  6. Ahmed Toma
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  7. Lewis Thorne
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Corresponding author

Correspondence to Francesco Magni.

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Ethics approval

26-202223-CA

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Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Comments

In this paper, Magni et al. describe a clinical observation of falsely increased ICP readings immediately after insertion of a parenchymal ICP monitor. They studied 10 patients in which elective ICP monitoring was performed due to suspicion of different clinical diagnoses characterized by abnormal ICP. They present findings of high ICP values gradually falling to a plateau after approximately 20 min. This initial ‘ICP spike’ might be explained by different factors of which the most intuitively obvious explanation would be the local trauma and/or local mass effect of the sensor tip in the brain tissue. It would be interesting to see if the phenomenon could be reproduced in (gold standard) measurements through an external ventricular drain and in acute cases of intracranial hypertension. Awareness of an initial ICP spike after ICP sensor insertion would have an impact especially in acute, severe TBI where ICP readings guide initial surgical and medical treatment.

Alexander Lilja-Cyron

Copenhagen, Denmark

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Key points

Question: In the context of elective intracranial pressure (ICP) monitoring, how does ICP change in the immediate period following dural breach?

Findings: Immediately following insertion of the ICP monitoring device, we record an opening pressure spike. ICP subsequently falls over the course of 20 min before it plateaus.

Meaning: At present, only anecdotal evidence of this phenomenon exists. Our preliminary study paves the way for future research to explore its aetiology, ultimately informing interpretation and management of raised ICP.

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Magni, F., Khawari, S., Pandit, A. et al. The initial intracranial pressure spike phenomenon. Acta Neurochir 165, 3239–3242 (2023). https://doi.org/10.1007/s00701-023-05780-7

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  • DOI: https://doi.org/10.1007/s00701-023-05780-7

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