• J Neurosurg Anesthesiol · Jul 2010

    Pressure inside the neuroendoscope: correlation with epidural intracranial pressure during neuroendoscopic procedures.

    • Lydia Salvador, Ricard Valero, Jesús Carazo, Luis Caral, José Rios, Enrique Carrero, Javier Tercero, Nicolas de Riva, Paola Hurtado, Enrique Ferrer, and Neus Fábregas.
    • Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain.
    • J Neurosurg Anesthesiol. 2010 Jul 1;22(3):240-6.

    BackgroundDuring neuroendoscopic procedures, pressure inside the neuroendoscope (PIN) monitored through the irrigation channel correlates with the occurrence of postoperative complications. Our aim was to analyze the reliability of PIN measurement as a surrogate for intracranial pressure (ICP) by comparing PIN with simultaneously epidural ICP measurement as the standard.MethodsSeventeen consecutive patients undergoing neuroendoscopy were studied prospectively. Type and length of procedure and PIN and epidural ICP values during neuroendoscopy were recorded. Lin's concordance coefficient and Bland-Altman analysis of agreement were used to assess correspondence between the 2 systems.ResultsA consistent relation between PIN and epidural ICP waveforms was observed during neuroendoscopic navigation. A strong Pearson correlation between PIN and epidural ICP data were found in 15 patients. Epidural ICP values were systematically higher than PIN values in 15 patients. Lin concordance coefficients showed moderate global agreement between the 2 methods, at 0.58 (95% confidence interval, 0.577-0.592). In 6 cases (35.2%) concordance was good according to this analysis, in 7 cases (41.2%) agreement was moderate/fair, and in 4 cases (23.5%) agreement was poor. The Bland-Altman analysis of patient data showed good agreement between the PIN and epidural ICP measurements for most patients, although discrepancies were greater at higher ICP values for 11 patients. Bland-Altman analysis of the complete dataset, after the normalization of individual's measurements, showed good overall agreement.ConclusionsPIN measurement seems useful for evaluating ICP changes related to neuroendoscopic procedures and seems to be more consistent than epidural ICP at high pressures.

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