Abstract
BackgroundAlthough widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values.MethodA systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals.ResultsThirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were − 5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively.ConclusionsThis systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter.
Highlights
Widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented
This study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter
It is well known that intracranial pressure (ICP) changes with body position [8, 18,19,20,21], e.g., ICP is lower in the vertical position compared to the horizontal position [8, 19, 21]
Summary
Widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. In the 1920s and 30 s, it was assumed that ICP measured intracranially was equal to LCSFop measured at a lumbar spine level [11, 12] This has, in recent years, been subject to much debate [13,14,15,16,17], and where some studies have documented similar values for intracranial measurements and lumbar measurements [13, 15], others found considerable differences between the two measurement-sites [14, 16, 17]. This systematic review aims to (1) determine reference values for normal ICP and LCSFop, and (2) examine how ICP depends on measurement-site and body position
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