title: Intracranial pressure monitoring during adult spinal deformity correction in a patient with critical venous occlusive disease and superior vena cava syndrome: A technical note.
abstract: BACKGROUND
  Intracranial pressure (ICP) monitoring is not routinely used during complex spinal deformity correction surgery. The authors report a 66-year-old male who during thoracolumbar deformity surgery required the placement of an ICP monitor due to the underlying history of a superior vena cava syndrome (e.g., s/p right jugular stent).
  
  
  METHODS
  A 66-year-old male with multiple prior lumbar spinal procedures presented with lower back and bilateral lower extremity pain, paresthesias, and weakness. He had a history of chronic left internal jugular and brachiocephalic venous occlusion (e.g., he had a right internal jugular stent). During deformity surgery, a frontal intraparenchymal ICP monitor was placed. During the early portion of the operation, bed adjustments (increasing reverse trendelenburg position) were required to compensate for ICP elevations as high as 30 mm Hg. A subsequent inadvertent durotomy during decompression lowered the ICP to <5 mm Hg; no further ICP spikes occurred. His postoperative course was uneventful, and 14-month later, he was dramatically improved.
  
  
  CONCLUSIONS
  ICP monitoring may be a useful adjunct for patient safety in selected patients who are at risk for developing intracranial hypertension during extensive spinal deformity surgery.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Ozpinar
authors.affiliation: Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Tempel
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Choi
authors.affiliation: Department of Orthopedic Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
keywords: Deformity correction; intracranial pressure monitoring; superior vena cava syndrome