title: Characterisation of Supra- and Infratentorial ICP Profiles.
abstract: In pathophysiology and clinical practice, the intracranial pressure (ICP) profiles in the supratentorial and infratentorial compartments are unclear. We know that the pressure within the skull is unevenly distributed, with demonstrated ICP gradients. We recorded and characterised the supra- and infratentorial ICP patterns to understand what drives the transtentorial ICP gradient.A 70-year-old man was operated on for acute cerebellar infarction. One supratentorial probe and one cerebellar probe were implanted. Both signals were recorded concurrently and analysed off-line. We calculated mean ICP, ICP pulse amplitude, respiratory waves, slow waves and the RAP index of supra- and infratentorial ICP signals. Then, we measured transtentorial difference and performed correlation analysis for every index.Supratentorial ICP mean was 8.5 mmHg lower than infratentorial ICP, but the difference lessens for higher values. Both signals across the tentorium showed close correlation. Supra- and infratentorial pulse amplitude, respiratory waves and slow waves also showed a high degree of correlation. The compensatory reserve (RAP) showed good correlation. In this case report, we demonstrate that the mean value of ICP is higher in the posterior fossa, with a strong correlation across the tentorium. All other ICP-derived parameters display a symmetrical profile.
authors.affiliation: Department of Neurosurgery, Hôpital Purpan, Place du Dr Baylac TSA 40031, 31059, Toulouse, France. moyse.e@chu-toulouse.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Moyse
authors.affiliation: Department of Neurosurgery, Hôpital Purpan, Place du Dr Baylac TSA 40031, 31059, Toulouse, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ros
authors.affiliation: Department of Neuro Anaesthesia - Intensive Care, Hôpital Purpan, Toulouse, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Marhar
authors.affiliation: Institute of Fluid Mechanics, Paul Sabatier University III, Toulouse, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Swider
authors.affiliation: Department of Neurosurgery, Hôpital Purpan, Place du Dr Baylac TSA 40031, 31059, Toulouse, France.
authors.forename: Eric Albert
authors.initials: EA
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000503:physiopathology* / Q000601:surgery; D002526:Cerebellar Diseases / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008991:Monitoring, Physiologic; D013116:Spinal Cord
keywords: Intracranial pressure; Monitoring; Posterior fossa; Signal processing; Transtentorial gradient