Intracranial pressure wave morphological classification: automated analysis and clinical validation.

Background: Recently, different software has been developed to automatically analyze multiple intracranial pressure (ICP) parameters, but the suggested methods are frequently complex and have no clinical correlation. The objective of this study was to assess the clinical value of a new morphological classification of the cerebrospinal fluid pulse pressure waveform (CSFPPW), comparing it to the elastance index (EI) and CSF-outflow resistance (Rout), and to test the efficacy of an automatic ICP analysis.

Methods: An artificial neural network (ANN) was trained to classify 60 CSFPPWs in four different classes, according to their morphology, and its efficacy was compared to an expert examiner's classification.

Blood flow velocities during experimental intracranial hypertension in pigs.

Objectives: A purely hydraulic mechanism consisting in the pulsatile cuff-compression effect, by the cerebrospinal fluid displacement induced by the arterial pulsation, on the final portion of the bridging veins, has recently been hypothesized. This mechanism is able to maintain the constancy of cerebral blood flow (CBF) within the autoregulatory range, thus implying an exact balance between arterial inflow and venous outflow. In this study, we correlated arterial inflow and venous outflow during an experimentally induced condition of intracranial hypertension in pigs.

An experimental study on artificially induced CSF pulse waveform morphological modifications.

Objective: The analysis of cerebrospinal fluid (CSF) pulse pressure waveform has been considered as a reliable method to investigate the intracranial system (ICS) dynamics. We have examined the morphological changes of the CSF pulse wave and of the sagittal sinus pressure (SSP) wave during a progressive increase in intracranial pressure (ICP) in order to investigate the ICS dynamics.

Methods: Four dogs were anesthetized.

Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience.

Object: The ability to predict outcome after shunt placement in patients with idiopathic normal-pressure hydrocephalus (NPH) represents a challenge. To date, no single diagnostic tool or combination of tools has proved capable of reliably predicting whether the condition of a patient with suspected NPH will improve after a shunting procedure. In this paper, the authors report their experience with 120 patients with the goal of identifying CSF hydrodynamics criteria capable of selecting patients with idiopathic NPH.

Prolonged intracranial pressure (ICP) monitoring in non-traumatic pediatric neurosurgical diseases.

Background: A limited number of studies have addressed the methods, indications and particular problems that may occur when programming prolonged intracranial pressure (ICP) monitoring in pediatric patients. Parenchymal fiberoptic transducers have been shown to give reliable ICP readings; moreover, they present a relatively low rate of complications, are easily placed and, as they are solid state, they are not subject to obstruction.

Material/methods: A recently developed fiberoptic ICP transducer (Codman intraparenchymal sensor) was used to continuously monitor intracranial pressure in seventy children with non-traumatic neurosurgical diseases.

Prolonged ICP monitoring in Sylvian arachnoid cysts.

Background: The decision making process for patients with Sylvian fissure arachnoid cysts still represents a challenge for the neurosurgeon. A high percentage of patients are indeed asymptomatic, despite neuroimaging signs of apparently increased intracranial pressure (ICP). The present study was conducted to evaluate the usefulness of prolonged ICP recording in the preoperative work-up.