The Roll of Continuous ICP Monitoring for the Application of Shunt Operation in Adult Ventriculomegaly Patients

We evaluated one month follow-up results of the 12 adult patients who showed ventriculomegaly in the aspects of symptoms. Evans ratio, periventricular low density, grades of radio-isotope cisternography, and grades of continuous intracranial pressure monitoring that were classified on the pressure wave and basal pressure level. The grades of continuous ICP monitoring were compared to the grades of radio-isotope cisternography. History, symptoms, CT findings, and radio-isotope cisternography are often helpful to decide shunt operation but sometimes continuous intracranial pressure monitoring gives invaluable information.

Comparison of Intracranial Pressure on Different Monitoring Sites

To compare intrahematomal pressure(IH) with epidural pressure(EP), lumbar subarachnoid pressure(LP) and intraventricular pressure(IV), 34 intracerebral hemorrhage patients from Dec. 1986 to Aug. 1987 were selected. We measured IH via stereotacically placed catheter and at the same time, we measured EP with fiberoptic sensor, LP by lumbar puncture and IV via stereotactically placed catheter during communication between hematoma and ventricle. The results obtained were as follows : 1) IH was the highest in most cases and IH, IV, LP and EP in orders by mean values. 2) In distribuion of EP, LP and IV compared with IH, EP had wide range of distribution(17~500%) compared to LP and IV. 3) There was a tendency of increased rate of higher IH than EP according to increased size of hematoma. 4) There was a tendency of increased rate of higher IH than EP in thalamic hemorrhage than putaminal hemorrhage. 5) ICP curves showed abrupt increase or decrease in cases of rebleeding or communication between hematoma and ventricle. 6) In analysis of low IH compared with EP and LP, the causes were due to checking of IH just after aspiration of large amount of hematoma(3 cases) and normal variations(6 cases). 7) In analysis of failed monitoring, EP was 5 cases(19%) and IH was 3 cases(8.8%) so more failed monitoring were found in EP than IH and there was no failed cases in LP and IV. From above results, we concluded that IH was the highest in most cases and EP was less reliable than other pressures.