Poca Maria A, Lopez-Bermeo Diego, Cano Paola, Maruccia Federica, Fajardo Carolina, Delgado Ignacio, Munar Francisca, Garcia-Merino Anna, Sahuquillo Juan
Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
J Clin Med. 2025 Apr 28;14(9):3042. doi: 10.3390/jcm14093042.
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. 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). 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. Patients with BEH may present significant abnormalities in ICP. Monitoring this variable in certain cases can assist in determining the necessity for surgical treatment.
本研究旨在评估连续颅内压（ICP）监测在诊断为良性外部脑积水（BEH）的巨头畸形或头围（HC）迅速增加的儿童中的结果。在此，我们报告了36例诊断为BEH的儿童在连续监测至少48小时后的绝对ICP测量值、ICP搏动性和缓慢ICP波。对36例连续的巨头畸形（HC高于第97.5百分位数）或HC迅速增加（至少跨越两条百分位数曲线）且诊断为BEH的儿童（22例男孩和14例女孩，平均年龄23.6±13.3个月，最小6个月，最大65个月）进行了连续ICP监测的前瞻性研究，使用硬膜外传感器。对于研究中的前四个儿童，使用模拟记录仪获取ICP值的硬拷贝。从第五个患者开始，ICP信号以200Hz采样，并使用基于计算机的数据采集和分析系统（LabChart v8.1软件）存储在计算机上。20例患者（55.6%）出现临床体征或症状。分别有18例（50%）和20例（55.6%）患者出现运动或语言发育迟缓。在13例患者中，发现蛛网膜下腔扩大与另一种情况相关。整个队列的平均ICP值中位数为17mmHg，最小值为6.7mmHg，最大值为29mmHg。所有患者夜间B波百分比均超过20%，中位数为47.4%（最小值：23.2，最大值：75）。三个儿童出现夜间平台波。夜间，常规ICP记录与ICP显著增加的时期交替出现，通常超过基线值10mmHg以上。在这些发作期间观察到高振幅B波，B波峰值处的心电波形振幅始终大于5mmHg，显示出异常形态（P2>P1）。36例患者中有30例植入了脑室腹腔分流管。BEH患者可能存在显著的ICP异常。在某些情况下监测这一变量有助于确定手术治疗的必要性。
