title: Noninvasive epicutaneous transfontanelle intracranial pressure monitoring in children under the age of 1 year: a novel technique.
abstract: Monitoring of intracranial pressure (ICP) may be indicated in children with traumatic brain injury, premature intraventricular hemorrhage, or hydrocephalus. The standard technique is either a direct measurement with invasive intracranial insertion of ICP probes or indirect noninvasive assessment using transfontanelle ultrasonography to measure blood flow. The authors have developed a new technique that allows noninvasive epicutaneous transfontanelle ICP measurement with standard ICP probes. They compared the ICP measurements obtained using the same type of standard probe used in 2 different ways in 5 infants (age < 1 year) undergoing surgery for craniosynostosis. The first ICP probe was implanted epidurally (providing control measurements) and the second probe was fixed epicutaneously on the skin over the reopened frontal fontanelle. ICP values were measured hourly for the first 24 hours after surgery and the values obtained with the 2 methods were compared using Bland-Altman 2-methods analysis. A total of 110 pairs of measurements were assessed. There was no significant difference between the ICPs measured using the epicutaneous transfontanelle method (mean 13.10 mm Hg, SEM 6.68 mm Hg) and the epidural measurements (mean 12.46 mm Hg, SEM 6.45 mm Hg; p = 0.4643). The results of this analysis indicate that epicutaneous transfontanelle measurement of ICP is a reliable method that allows noninvasive ICP monitoring in children under the age of 1 year. Such noninvasive ICP monitoring could be implemented in the therapy of children with traumatic brain injury or intraventricular hemorrhage or for screening children with elevated ICP without invasive intracranial implantation of ICP probes.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Bedjan
authors.initials: B
authors.lastname: Behmanesh
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Anika
authors.initials: A
authors.lastname: Noack
authors.affiliation: Neuropaediatrics, Goethe University, Frankfurt am Main, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Bartels
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Johanna
authors.initials: J
authors.lastname: Quick-Weller
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Freiman
mesh_terms: D003398:Craniosynostoses / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D064926:Neurophysiological Monitoring / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: ICP = intracranial pressure; TBI = traumatic brain injury; children; craniosynostosis; noninvasive ICP monitoring; technique