Best zero level for external ICP transducer
Reinstrup, Peter LU ; Unnerbäck, Mårten LU ; Marklund, Niklas LU
; Schalen, Wilhelm
LU
; Arrocha, Jesus Cabrera
; Bloomfield, Eric L.
; Sadegh, Vahabi
and Hesselgard, Karin
LU
(2019)
In Acta Neurochirurgica
161(4).
p.635-642
- Abstract
Background: Continuous monitoring of intracranial pressure (ICP) was introduced in the 1950s. For correct ICP recordings, the zero-reference point for the external pressure gauge must be placed next to a head anatomical structure. We evaluated different anatomical points as zero reference for the ICP device at different head positions and their relation to brain centre (BC), foramen of Monro (Monro), and brain surface. Methods: Patients referred for neuroimaging due to e.g. headache all having normal 3D MRI scans were selected. Monro, BC, Orbit(O), external auditory meatus (EAM), and orbito-meatal (OM) line were identified and projected to mid-sagittal, or axial images. Each scan was evaluated like lying supine, 45° head elevations,... (More)
Background: Continuous monitoring of intracranial pressure (ICP) was introduced in the 1950s. For correct ICP recordings, the zero-reference point for the external pressure gauge must be placed next to a head anatomical structure. We evaluated different anatomical points as zero reference for the ICP device at different head positions and their relation to brain centre (BC), foramen of Monro (Monro), and brain surface. Methods: Patients referred for neuroimaging due to e.g. headache all having normal 3D MRI scans were selected. Monro, BC, Orbit(O), external auditory meatus (EAM), and orbito-meatal (OM) line were identified and projected to mid-sagittal, or axial images. Each scan was evaluated like lying supine, 45° head elevations, upright, and 45° lateral position. Distances from skin to brain surface, BC, and Monro were measured. All values are presented as mean ± SD and/or range in millimetre. For conversion to mmHg, millimetre was multiplied by 0.074. Results: Twenty MRI scans were examined. A zero reference at EAM or glabella was ideal at BC when head was strict supine or in the lateral position. At 45° head elevation, an overestimation of the BC-ICP by 4.8 ± 0.8 and in upright 5.6 ± 0.5 mmHg was found, and 45° lateral underestimated ICP-BC by 6.3 ± 1.0 mmHg. Monro was situated 45 ± 5 mm rostral to the mid-OM line and 24 (18–31) mm inferior and 13 (8–17) mm in front of BC. A zero-reference point aligned with the highest point of the head underestimated BC-ICP and Monro-ICP. If the ICP reading was added 5.9 or 6.3 mmHg, respectively, a deviation from BC-ICP was ≤ 1.8 mmHg and Monro-ICP was ≤ 0.9 mmHg in all head positions. Conclusions: EAM and glabella are defined anatomical structures representing BC when strict supine or lateral but with 12 mmHg variation with different head positions used in clinical practice. The OM line follows Monro at head elevation, but not when the head is turned. When the highest external point on the head is used, ICP values at brain surface as well as Monro and BC are underestimated. This underestimation is fairly constant and, when corrected for, provides the most exact ICP reading.
(Less)
- author
- Reinstrup, Peter
LU
; Unnerbäck, Mårten
LU
; Marklund, Niklas
LU
; Schalen, Wilhelm
LU
; Arrocha, Jesus Cabrera
; Bloomfield, Eric L.
; Sadegh, Vahabi
and Hesselgard, Karin
LU
- organization
- publishing date
- 2019-03-08
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ICP, Intracranial pressure, Monitoring, Zero reference point
- in
- Acta Neurochirurgica
- volume
- 161
- issue
- 4
- pages
- 635 - 642
- publisher
- Springer
- external identifiers
-
- pmid:30848373
- scopus:85062889373
- ISSN
- 0001-6268
- DOI
- 10.1007/s00701-019-03856-x
- language
- English
- LU publication?
- yes
- id
- 91fe46c6-6580-4420-8a00-0e99841152ac
- date added to LUP
- 2019-03-21 13:38:56
- date last changed
- 2024-06-11 07:04:27
@article{91fe46c6-6580-4420-8a00-0e99841152ac,
abstract = {{<p>Background: Continuous monitoring of intracranial pressure (ICP) was introduced in the 1950s. For correct ICP recordings, the zero-reference point for the external pressure gauge must be placed next to a head anatomical structure. We evaluated different anatomical points as zero reference for the ICP device at different head positions and their relation to brain centre (BC), foramen of Monro (Monro), and brain surface. Methods: Patients referred for neuroimaging due to e.g. headache all having normal 3D MRI scans were selected. Monro, BC, Orbit(O), external auditory meatus (EAM), and orbito-meatal (OM) line were identified and projected to mid-sagittal, or axial images. Each scan was evaluated like lying supine, 45° head elevations, upright, and 45° lateral position. Distances from skin to brain surface, BC, and Monro were measured. All values are presented as mean ± SD and/or range in millimetre. For conversion to mmHg, millimetre was multiplied by 0.074. Results: Twenty MRI scans were examined. A zero reference at EAM or glabella was ideal at BC when head was strict supine or in the lateral position. At 45° head elevation, an overestimation of the BC-ICP by 4.8 ± 0.8 and in upright 5.6 ± 0.5 mmHg was found, and 45° lateral underestimated ICP-BC by 6.3 ± 1.0 mmHg. Monro was situated 45 ± 5 mm rostral to the mid-OM line and 24 (18–31) mm inferior and 13 (8–17) mm in front of BC. A zero-reference point aligned with the highest point of the head underestimated BC-ICP and Monro-ICP. If the ICP reading was added 5.9 or 6.3 mmHg, respectively, a deviation from BC-ICP was ≤ 1.8 mmHg and Monro-ICP was ≤ 0.9 mmHg in all head positions. Conclusions: EAM and glabella are defined anatomical structures representing BC when strict supine or lateral but with 12 mmHg variation with different head positions used in clinical practice. The OM line follows Monro at head elevation, but not when the head is turned. When the highest external point on the head is used, ICP values at brain surface as well as Monro and BC are underestimated. This underestimation is fairly constant and, when corrected for, provides the most exact ICP reading.</p>}},
author = {{Reinstrup, Peter and Unnerbäck, Mårten and Marklund, Niklas and Schalen, Wilhelm and Arrocha, Jesus Cabrera and Bloomfield, Eric L. and Sadegh, Vahabi and Hesselgard, Karin}},
issn = {{0001-6268}},
keywords = {{ICP; Intracranial pressure; Monitoring; Zero reference point}},
language = {{eng}},
month = {{03}},
number = {{4}},
pages = {{635--642}},
publisher = {{Springer}},
series = {{Acta Neurochirurgica}},
title = {{Best zero level for external ICP transducer}},
url = {{http://dx.doi.org/10.1007/s00701-019-03856-x}},
doi = {{10.1007/s00701-019-03856-x}},
volume = {{161}},
year = {{2019}},
}