Long-term telemetric intracranial pressure monitoring for diagnosis and therapy optimisation of idiopathic intracranial hypertension

Victor F Velazquez Sanchez,Christoph A Tschan,Giath Al Dayri

doi:10.1186/s12883-021-02349-8

Victor F Velazquez Sanchez, Christoph A Tschan + Show 1 more

Open Access

https://doi.org/10.1186/s12883-021-02349-8

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Journal: BMC Neurology	Publication Date: Sep 7, 2021
Citations: 6	License type: open-access

Abstract

BackgroundIdiopathic intracranial hypertension (IIH) is a disease which is difficult to diagnose and moreover difficult to treat. We developed a strategy for long-term telemonitoring of intracranial pressure (ICP), by incorporation of the NEUROVENT®-P-tel System, with the goal of improved diagnosis and consequent therapy of this disease. We highlight the results obtained through this approach.MethodsTwenty patients with suspected IIH who were treated in our hospital from August 2014 to October 2020 (16 females, 4 males, median age 36,6 years), were assigned to one of two ICP monitoring settings, “Home-Telemonitoring” (n = 12) and “Home-Monitoring” (n = 8). The ICP data were analysed and used conjointly with the accompanying clinical picture for establishment of IIH diagnosis, and telemonitoring was resumed for therapy optimisation of confirmed cases.ResultsThe diagnosis of IIH was confirmed in 18 of the 20 patients. Various surgical/interventional treatments were applied to the confirmed cases, including ventriculoperitoneal (VP) shunting (n = 15), stenting of the transvers venous sinus (n = 1), endoscopic third ventriculostomy (ETV) (n = 1), and ETV in combination with endoscopic laser-based coagulation of the choroid Plexus (n = 1). Optimal adjustment of the implanted shunt valves was achieved with an average valve opening pressure of 6,3 ± 2,17 cm H2O for differential valves, and of 29,8 ± 3,94 cm H2O for gravitational valves. The Home-Telemonitoring setting reduced consequent outpatient visits, compared to the Home-Monitoring setting, with an average of 3,1 visits and 4,3 visits, respectively. No complications were associated with the surgical implantation of the P-tel catheter.ConclusionThis study offers insight into the use of long-term ICP monitoring for management of IIH patients in combination with dual-valve VP shunts. The use of NEUROVENT® P-tel system and potentially other similar fully implantable ICP-monitoring devices, albeit invasive, may be justified in this complex disease. The data suggest recommending an initial adjustment of dual-valve VP-shunts of 30 and 6 cm H2O, for gravitational and differential valves, respectively. Further research is warranted to explore potential integration of this concept in IIH management guidelines.

Highlights

Idiopathic intracranial hypertension (IIH) is a disease which is difficult to diagnose and difficult to treat
Some authors suggest the use of the term “secondary intracranial hypertension” if the etiology of the elevated intracranial pressure (ICP) was clear, for instance as a side effect of medical treatment, or as part of post-thrombotic transverse sinus stenosis; it is unclear if sinus stenosis in association with IIH is a primary cause or a consequence of the elevated ICP [9, 20]
Many factors render the diagnosis of this disease difficult, such as low disease incidence, the unspecific signs and symptoms associated with this disease, and lack of clear radiological findings especially in the early phases of this disease, combined with the lack of reliable non-invasive methods for measurement of the ICP for confirmation of intracranial hypertension; which is why some patients may suffer for years before diagnosis of IIH is established

Summary

Introduction

Idiopathic intracranial hypertension (IIH) is a disease which is difficult to diagnose and difficult to treat. Many factors render the diagnosis of this disease difficult, such as low disease incidence (estimated to be around 4.7 per 100.000 in the general population [13]), the unspecific signs and symptoms associated with this disease, and lack of clear radiological findings especially in the early phases of this disease, combined with the lack of reliable non-invasive methods for measurement of the ICP for confirmation of intracranial hypertension; which is why some patients may suffer for years before diagnosis of IIH is established. IIH patients are stigmatized as difficult-to-treat patients, and since the chief complaint in most cases is headache, which is subjective, it is frequently not addressed as promptly as it should.

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