Introduction: Non-invasive ICP methods are now available. The correlation of symptoms and signs of intracranial hypertension with actual ICP measurements in patients with large intracranial tumors is controversial.The objective of this study was to evaluate ICP in patients presenting with signs and symptoms of elevated ICP, and assess the value and utility of non-invasive ICP monitoring.
Methods: Twenty patients underwent non-invasive ICP using a two-depth transcranial Doppler ultrasound designed to simultaneously compare pulse dynamics in the proximal (intracranial), and the distal (extracranial) intraorbital segments of the Ophthalmic artery through the closed eyelid.
Results: Twenty-eight measurements were analyzed. Radiological characteristics included tumor volume (range=5.45-220.27cm3, mean=48.81 cm3), perilesional edema (range=0-238.27cm3, mean=74.40cm3), and midline shift (mean=3.99mm). All ICP measurements were in the normal range of 7-15 mmHg (ICPmean:9.19 mmHg). The correlation of demographics, clinical and radiological variables in a bivariate association, showed a statistically significant correlation with neurological deficits and ICPmax (p=0.02) as well as ICPmean (p=0.01). The correlation between ICP and neurological deficits, showed a negative value of the estimate. The ICP was not increased, whether ipsilateral or contralateral to the tumor. The multivariate model analysis demonstrated that neurological deficits were associated with lower ICPmax values, whereas maximum tumor diameter was associated with larger ICPmax values.
Conclusions: This study demonstrated that ICP in patients with intracranial tumors and mass effect is not necessarily increased; that the clinical signs of intracranial hypertension do not necessarily reflect increased ICP; and that non-invasive ICP measurement might become an important tool to determine the urgency of surgery and medical interventions.
Patient Care: It will help re-evaluate the role of intracranial pressure in the symptomatology of patients with brain tumors
Learning Objectives: By the conclusion of this session participants should develop a better appreciation for the complexity of ICP in patients with space occupying lesions, and of the role of non-invasive ICP in evaluating them