Pedersen Sarah Hornshøj, Norager Nicolas Hernandez, Lilja-Cyron Alexander, Juhler Marianne
Department of Neurosurgery, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
Childs Nerv Syst. 2020 Jan;36(1):49-58. doi: 10.1007/s00381-019-04271-4. Epub 2019 Jul 15.
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.
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.
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).
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.
重复测量颅内压（ICP）对于治疗复杂脑脊液（CSF）疾病患者至关重要。这些患者通常有较长的手术史，经历过多次侵入性腰椎或颅内压监测以及/或脑室腹腔（VP）分流术修复。遥测ICP监测可能是治疗这些患者的有利工具。在本文中，我们评估了我们在儿科患者中使用该技术的经验。
在4年期间，我们为20名儿科患者植入了遥测ICP传感器（ Raumedic NEUROVENT-P-tel），以尽量减少未来侵入性操作的次数。患者被诊断患有脑积水、特发性颅内高压（IIH）或蛛网膜囊肿。大多数患者（85%）在传感器植入时已有VP分流。
20名患者共植入32个传感器；再次植入的原因是植入物技术故障。一个传感器因伤口感染被取出，一个因皮肤侵蚀被取出。我们没有遇到与植入/取出程序直接相关的并发症。共进行了149次记录，包括68次家庭监测。植入的中位时间为523天，临床使用的中位持续时间为202天。记录最可能的结果是非手术治疗调整（分流阀调整或乙酰唑胺剂量调整）。
儿童遥测ICP监测是安全的，并且可能减少侵入性操作的次数。我们发现遥测ICP监测有助于复杂CSF疾病患者的临床管理，并改善患者及其父母的日常生活。它允许在患者家中连续测量ICP，从而有可能减少住院次数，显著节省成本。
