Introduction: A lumbar puncture as a means of measuring intracranial pressure (ICP) is limited by being a single time point evaluation and patient cooperation especially in children. However a microsensor placed in the brain is considered the gold standard because it is not affected by posture and it allows the child to mimic home activity over a longer period of time. A study was therefore carried out to investigate the reliability of lumbar puncture when compared to intracranial pressure monitor with microsensor device for elective evaluation of suspected intracranial hypertension.
Methods: All patients who had both a lumbar puncture and ICP monitor were reviewed over a three year period. Demographic data, indication for the ICP monitor placement including clinical features, primary diagnosis and the lumbar puncture pressure and the incranial pressure monitor pressures were collected and analyzed for this study. Statistical analysis was with SPSS v 20 accepting a p-value of less than 0.05 as significant.
Results: There were 12 children (7females: 5males) aged 2 - 19yrs (mean 11.1). The mean ICP measured at lumbar puncture was 22mmHg (range 18-26) and the mean ICP as measured with the microsensor (Camino bolt) was 7mmHg (range 3-12, p < 0.0001). The primary diagnosis was craniosynostosis in 7 patients, hydrocephalus in 4 patients and pseudotumor in 1 patient. All patients had headache and there was no papilledema. The anticipated surgical intervention was avoided in all the patients.
Conclusions: This study found a significant difference in the ICP measured by lumbar puncture and ICP monitor. We would recommend the use of ICP monitor in the evaluation of possible chronic raised intracranial pressure rather than a lumbar puncture.
Patient Care: It is going to prevent the use of lumbar puncture as basis for correction of craniosynostosis.
Learning Objectives: Lumbar puncture overestimate ICP
Singificant variation between ICP microsensor pressure and lumbar puncture pressures.