Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series.
Non-invasive measurement of ICP (nICP) can be warranted in patients at risk for developing increased ICP during pneumoperitoneum (PP). Our aim was to assess available data on the application of nICP monitoring during these procedures and to present a patient assessed with an innovative combination of noninvasive tools. Literature review of nICP assessment during PP did not find any studies comparing different methods intraprocedurally and only few studies of any nICP monitoring were available: transcranial Doppler (TCD) studies used the pulsatility index (PI) as an estimator of ICP and failed to detect a significant ICP increase during PP, whereas two out of three optic nerve sheath diameter (ONSD) studies detected a statistically significant ICP increase. In the case study, we describe a 52 year old man with a high grade thalamic glioma who underwent urgent laparoscopic cholecystectomy. Considering the high intraoperative risk of developing intracranial hypertension, he was monitored through parallel ONSD ultrasound measurement and TCD derived formulae (flow velocity diastolic formula, FVdnICP, and PI). ONSD and FVdnICP methods indicated a significant ICP increase during PP, whereas PI was not significantly increased. Our experience, combined with the literature review, seems to suggest that PI might not detect ICP changes in this context, however we indicate a possible interest of nICP monitoring during PP by means of ONSD and of TCD derived FVdNICP, especially for patients at risk for increased ICP.
Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK. kiarobba@gmail.com.
C
C
Robba
Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
S
S
Bacigaluppi
Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy.
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D
Cardim
Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy.
J
J
Donnelly
Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, Canada.
M S
MS
Sekhon
Department of Critical Care, University of Groningen, Groningen, The Netherlands.
M J
MJ
Aries
Section of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
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G
Mancardi
Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
A
A
Booth
Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.
N L
NL
Bragazzi
Department of Neurosurgery, Galliera Hospital, University of Genoa, Genoa, Italy.
M
M
Czosnyka
Neurosciences Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
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B
Matta
D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods*; D009900:Optic Nerve / Q000473:pathology; D011027:Pneumoperitoneum / Q000503:physiopathology*; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D017585:Ultrasonography, Doppler, Transcranial
Intraoperative monitoring; Non invasive intracranial pressure; Optic nerve sheet diameter; Pneumoperitonaeum