>Objectives: To explore the outcome of management of possible shunt related symptoms using intracranial pressure (ICP) monitoring, and to identify potential methodological limitations with the current strategies of ICP assessment. >Methods: The distribution of persistent symptoms related to extracranial shunt treatment was compared before and after management of shunt failure in 69 consecutive hydrocephalic cases. Management was heavily based on ICP monitoring (calculation of mean ICP and visual determination of plateau waves). After the end of patient management, all ICP curves were re-evaluated using a quantitative method and software (SensometricsTM pressure analyser). The ICP curves were presented as a matrix of numbers of ICP elevations (20 to 35 mm Hg) or depressions (-10 to -5 mm Hg) of different durations (0.5, 1, or 5 minutes). The numbers of ICP elevations/depressions standardised to 10 hours recording time were calculated to allow comparisons of ICP between individuals. >Results: After ICP monitoring and management of the putative shunt related symptoms, the symptoms remained unchanged in as many as 58% of the cases, with the highest percentages in those patients with ICP considered normal or too low at the time of ICP monitoring. The quantitative analysis revealed a high frequency of ICP elevations (20 to 35 mm Hg lasting 0.5 to 1 minute) and ICP depressions (-10 to -5 mm Hg lasting 0.5, 1, or 5 minutes), particularly in patients with ICP considered normal. >Conclusions: The value of continuous ICP monitoring with ICP analysis using current criteria appears doubtful in the management of possible shunt related symptoms. This may reflect limitations in the strategies of ICP analysis. Calculation of the exact numbers of ICP elevations and depressions may provide a more accurate description of the ICP profile.
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机译:>目标 strong>:使用颅内压(ICP)监测探索可能与分流相关的症状的治疗结果,并通过当前ICP评估策略确定潜在的方法学局限性。 >方法: strong>比较了连续69例脑积水患者在处理分流失败前后与颅外分流治疗相关的持续症状的分布。管理主要基于ICP监视(平均ICP的计算和平台波的目测确定)。在患者管理结束后,使用定量方法和软件(Sensometrics TM sup>压力分析仪)重新评估所有ICP曲线。 ICP曲线以不同持续时间(0.5、1或5分钟)的ICP升高次数(20至35 mm Hg)或凹陷(-10至-5 mm Hg)的数量矩阵表示。计算标准化为10小时记录时间的ICP升高/降低的次数,以便比较个人之间的ICP。 >结果 strong>:在ICP监测和管理假定的分流相关症状后,多达58%的病例的症状保持不变,在那些认为ICP正常或过低的ICP患者中,百分比最高ICP监视时间。定量分析显示,ICP升高的频率较高(20至35 mm Hg持续0.5至1分钟)和ICP降低(-10至-5 mm Hg持续0.5、1或5分钟),特别是在被认为正常的ICP患者中。 >结论: strong>在使用可能的分流相关症状的管理中,使用当前标准进行ICP分析进行连续ICP监测的价值似乎令人怀疑。这可能反映出ICP分析策略的局限性。 ICP升高和降低的精确数量的计算可以提供ICP轮廓的更准确描述。
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