Posterior fossa ICP monitoring: a tale of two compartments. (4th March 2021)

• Record Type: Journal Article
• Authors: Khan, Amad; Borg, Nicholas; Shenouda, Emad
• Is Part Of: British journal of neurosurgery. Volume 35:Number 2(2021)
• Page Start: 129
• Page End: 132
• Publication Date: 2021-03-04
• Subjects: Posterior fossa -- ICP monitoring -- neuro-critical care; Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.1080/02688697.2020.1765974
• Languages: English
• ISSNs: 0268-8697

Abstract

Abstract: Aim: Measuring the intracranial pressure (ICP) of the infra-tentorial, posterior fossa compartment has long been avoided due to a lack of precedent and interpretability, as well as concern of damage to the underlying vital structures. In cases of posterior fossa insults however, the supra-tentorial compartment ICPs can be falsely reassuring. We aimed to measure the posterior fossa ICP in such a case and analyse the resulting data. Methods: We present a case of posterior fossa ICP monitoring and discuss its safety profile, rationale and possible indications. Results: Our comparison of the supra and infra-tentorial ICPs showed that there was a statistically significant difference in the two compartments. The infra-tentorial compartment had ICPs averaging 11.02 ± 2.24 mmHg whilst the supra-tentorial compartment averaged 4.94 ± 1.80 mmHg in the first 72 hours post-op (p < .01 on paired t-testing). After 72 hours, the pressures seemed to equilibrate and were 4.71 ± 2.6 and 3.88 ± 2.89 for the infra and supra-tentorial compartments respectively. Conclusion: We propose that where a patient with a posterior fossa insult exhibits signs and symptoms consistent with raised ICP but the supra-tentorial readings are normal, posterior fossa ICP monitoring can be considered.