• Koskinen Lars-Owe D LD Department of Clinical Neuroscience, Neurosurgery and Neurology, Umeå University, Umeå, 90185, Sweden. Lars-Owe.Koskinen@umu.se., Jan Malm, Rolandas Zakelis, Laimonas Bartusis, Arminas Ragauskas, and Anders Eklund.
• Department of Clinical Neuroscience, Neurosurgery and Neurology, Umeå University, Umeå, 90185, Sweden. Lars-Owe.Koskinen@umu.se.
• J Clin Monit Comput. 2017 Apr 1; 31 (2): 459-467.

AbstractMeasurement of intracranial pressure (ICP) is necessary in many neurological and neurosurgical diseases. To avoid lumbar puncture or intracranial ICP probes, non-invasive ICP techniques are becoming popular. A recently developed technology uses two-depth Doppler to compare arterial pulsations in the intra- and extra-cranial segments of the ophthalmic artery for non-invasive estimation of ICP. The aim of this study was to investigate how well non-invasively-measured ICP and invasively-measured cerebrospinal fluid (CSF) pressure correlate. We performed multiple measurements over a wide ICP span in eighteen elderly patients with communicating hydrocephalus. As a reference, an automatic CSF infusion apparatus was connected to the lumbar space. Ringer's solution was used to create elevation to pre-defined ICP levels. Bench tests of the infusion apparatus showed a random error (95 % CI) of less than ±0.9 mmHg and a systematic error of less than ±0.5 mmHg. Reliable Doppler signals were obtained in 13 (72 %) patients. An infusion test could not be performed in one patient. Thus, twelve patients and a total of 61 paired data points were studied. The correlation between invasive and non-invasive ICP measurements was good (R = 0.74), and the 95 % limits of agreements were -1.4 ± 8.8 mmHg. The within-patient correlation varied between 0.47 and 1.00. This non-invasive technique is promising, and these results encourage further development and evaluation before the method can be recommended for use in clinical practice.

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