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New Device Shows Promise for Less-Invasive Intracranial Pressure Monitoring

Home Monitoring Could Be Possible for Patients at Risk of Dangerous Pressure Increases

A new implantable sensor device provides a less-invasive alternative for monitoring pressure within the skull (intracranial pressure, or ICP), suggests a pilot study in  Operative Neurosurgery, a quarterly supplement to  Neurosurgery, official journal of the  Congress of Neurological Surgeons. Neurosurgery is published by  Lippincott Williams & Wilkins, a part of  Wolters Kluwer Health.

"This new telemetric system was safe and effective for ICP measurement over a long period, including home monitoring," according to the study by Dr. Stefan Welschehold of University Medicine, Mainz, Germany.

Initial Experience Supports Use of Telemetric ICP Monitor
The researchers evaluated the telemetric ICP monitoring system in ten patients with previous brain surgery. (Telemetry means "measurement over a distance.") The patients—including children as young as three—had conditions such as hydrocephalus (fluid buildup inside the skull) placing them at risk of increased ICP. Abnormally high ICP is a serious medical problem, with the potential to cause brain damage and death.

The telemetric ICP monitoring device consists of a miniature probe—about one inch long—attached to a disk-shaped transducer. A simple surgical procedure is performed to insert the probe tip into the brain through a small hole in the skull, and to place to transducer under the scalp.

To obtain ICP values, a recording device is simply held over the implanted sensor and transducer. Because the recording device is battery powered, the patients are completely mobile. Values can be measured even through bandages.

Eight patients continued ICP monitoring at home after being discharged from the hospital. Monitoring continued for up to six months. The main limitation was that the recording device had to be connected to a computer at least once every three weeks to clear space for data storage.

In seven out of ten patients, monitoring showed no abnormal increases in ICP and thus no need for further surgery. In these patients, the monitoring probe was eventually removed. In some cases, monitoring detected normal and temporary increases in ICP related to factors like position changes, exercise, or crying in children.

In the remaining three patients, monitoring showed persistent or recurrent increases in pressure inside the skull. This alerted doctors that further surgery was required to correct the cause of increased ICP.

Controlling ICP is a critical factor in the management of patients with hydrocephalus and certain other conditions. Current approaches to ICP monitoring have important disadvantages. The most accurate technique involves readings taken directly from a catheter inserted into the spaces within the brain. Catheter monitoring is an invasive procedure, with a significant of risk infections and other complications.

The preliminary results support the usefulness of the new system for less-invasive, fully mobile ICP monitoring. "The main advantage of this new telemetric ICP-monitoring system is the possibility of long-term measurement under daily life conditions," Dr. Welschehold and coauthors write.

Because the system is easily managed by patients and families, it may be especially valuable for ICP monitoring in children, the researchers believe. With further study—including comparison with established techniques—the new telemetric system could enable 24-hour monitoring, identifying patients with potentially serious increases in ICP while reducing the need for hospitalization and invasive tests.

About Neurosurgery
Neurosurgery, the Official Journal of the  Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the  LWW brand, as well as content-based sites and online corporate and customer services.

 LWW is part of  Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of  Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).