Abdominal Insufflation Is Associated With Increase of Intracranial Pressure in Patients With Normal Pressure Hydrocephalus. Issue 1 (17th October 2019)

• Record Type: Journal Article
• Authors: Bunevicius, Adomas; Vernon, Ashley; Golby, Alexandra
• Is Part Of: Operative neurosurgery. Volume 19:Issue 1(2020)
• Page Start: 53
• Page End: 56
• Publication Date: 2019-10-17
• Subjects: Normal-pressure hydrocephalus -- Ventriculoperitoneal shunt -- Abdominal insufflation; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opz319
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Ventriculoperitoneal shunting (VPS) is effective for the treatment of normal-pressure hydrocephalus (NPH) and sometimes requires laparoscopic assistance with abdominal insufflation. OBJECTIVE: To evaluate the association of abdominal insufflation with opening pressure (OP) in NPH patients undergoing VPS implantation. METHODS: Between March 2016 and April 2019, 52 consecutive patients who underwent first-time VPS implantation surgery were retrospectively identified by reviewing electronic health records. OP during the large volume lumbar tap test (OPLP ) and VPS implantation surgery (OPSURGERY ) were measured in 29 patients. RESULTS: Laparoscopic assistance with abdominal insufflation was used in 20 (69%) cases. There were no differences in patient age ( P = .589), gender ( P = .822), body mass index ( P = .289), weight ( P = .789), height ( P = .542), and OPLP ( P = .476) in patients operated with and without laparoscopic assistance. When compared to patients operated without laparoscopic assistance, laparoscopic assistance was associated with a greater rate of OP increase during surgery relative to OPLP (40% vs 100%, P = .002), a greater increase in OPSURGERY relative to OPLP (−0.40 ± 5.38 vs 10.17 ± 5.53 cm H2 O, P < .001), and a greater proportion of patients with OPSURGERY of ≥25 cm H2 O during the VPS surgery (0% vs 78%, P < .001). CONCLUSION: Abdominal insufflation is associated with an increase in intracranial pressure with OPs often exceeding 25 cm H2 O. This should be considered when selecting optimal VPS pressure settings.