Bharadwaj Suparna, Sundaram Mouleeswaran, Chakrabarti Dhritiman, Muthuchellappan Radhakrishnan
Department of Neuro Anaesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Asian J Neurosurg. 2024 Jun 18;19(3):402-407. doi: 10.1055/s-0044-1787536. eCollection 2024 Sep.
Knowledge of preoperative and intraoperative intracranial pressure (ICP) enables the neuroanesthesiologist to optimize cerebral perfusion pressure. However, ICP is rarely monitored during the intraoperative period. In this report, subdural site ICP measurement is validated with intraventricular ICP measurement, and the feasibility of subdural ICP monitoring during the intraoperative period is discussed. In this prospective pilot study, ICP measurement at the subdural site was achieved with an intravenous cannula and the ventricular site with a ventricular cannula. Both were transduced using a fluid-filled pressure transducer and connected to the monitor for display of the number and the waveforms. Monitoring of intraoperative ICP using both the techniques was done in all patients recruited into the study. The correlation between the two modalities of measurement was studied by the Spearman correlation test and their limits of agreement were studied using the Bland-Altman plot. A case series describing the perioperative management based on the subdural ICP values are also described. Subdural ICP showed a strong correlation with intraventricular ICP ( = 0.93, = 0.01). Agreement analysis using the Bland-Altman plot showed that the mean difference of ICP between the modalities was 1.44 mm Hg (95% confidence interval, -0.6 to 3.49, = 0.122). This study validates the ICP values measured at the subdural site with the intraventricular site. Subdural site ICP monitoring can be achieved rapidly with readily available systems and helps in making intraoperative clinical decisions. Cannula-based subdural ICP is a satisfactory alternative to intraventricular ICP monitoring in the intraoperative period.
了解术前和术中颅内压（ICP）有助于神经麻醉医生优化脑灌注压。然而，术中很少监测ICP。在本报告中，对硬膜下部位ICP测量与脑室内ICP测量进行了验证，并讨论了术中硬膜下ICP监测的可行性。
在这项前瞻性初步研究中，通过静脉套管实现硬膜下部位的ICP测量，通过脑室套管实现脑室部位的ICP测量。两者均使用充满液体的压力传感器进行转换，并连接到监测仪以显示数值和波形。所有纳入研究的患者均采用这两种技术进行术中ICP监测。通过Spearman相关性检验研究两种测量方式之间的相关性，并使用Bland-Altman图研究它们的一致性界限。还描述了一个基于硬膜下ICP值的围手术期管理的病例系列。
硬膜下ICP与脑室内ICP显示出很强的相关性（ = 0.93， = 0.01）。使用Bland-Altman图进行的一致性分析表明，两种测量方式之间ICP的平均差异为1.44 mmHg（95%置信区间，-0.6至3.49， = 0.122）。
本研究验证了硬膜下部位与脑室内部位测量的ICP值。使用现成的系统可以快速实现硬膜下部位ICP监测，并有助于做出术中临床决策。
基于套管的硬膜下ICP是术中脑室内ICP监测的一种令人满意的替代方法。
