The relationship between basal cisterns on CT and time-linked intracranial pressure in paediatric head injury.

Childs Nerv Syst

Division of Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Published: July 2011

AI Article Synopsis

  • The study investigates the relationship between the status of basal cisterns on head CT scans and intracranial pressure (ICP) in pediatric patients with severe traumatic brain injury (TBI).
  • It found that over 40% of scans with open cisterns still showed episodes of elevated ICP (≥ 20 mmHg), suggesting that open cisterns are not a reliable indicator for maintaining lower ICP levels.
  • The authors conclude that even when basal cisterns are open, it does not mean increased ICP should be ignored, emphasizing the need for consistent ICP monitoring in these patients.

Article Abstract

Purpose: Although intracranial pressure (ICP) monitoring is a cornerstone of care for severe traumatic brain injury (TBI), the indications for ICP monitoring in children are unclear. Often, decisions are based on head computed tomography (CT) scan characteristics. Arguably, the patency of the basal cisterns is the most commonly used of these signs. Although raised ICP is more likely with obliterated basal cisterns, the implications of open cisterns are less clear. We examined the association between the status of perimesencephalic cisterns and time-linked ICP values in paediatric severe TBI.

Methods: ICP data linked to individual head CT scans were reviewed. Basal cisterns were classified as open or closed by blinded reviewers. For the initial CT scan, we examined ICP values for the first 6 h after monitor insertion. For follow-up scans, we examined ICP values 3 h before and after scanning. Mean ICP and any episode of ICP ≥ 20 mmHg during this period were recorded.

Results: Data from 104 patients were examined. Basal cisterns were patent in 51.72% of scans, effaced in 34.48% and obliterated in 13.79%. Even when cisterns were open, more than 40% of scans had at least one episode of ICP ≥ 20 mmHg, and 14% of scans had a mean ICP ≥ 20 mmHg. The specificity of open cisterns in predicting ICP < 20 mmHg was poor (57.9%). Age-related data were worse.

Conclusion: Children with severe TBI frequently may have open basal cisterns on head CT despite increased ICP. Open cisterns should not discourage ICP monitoring.

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Source
http://dx.doi.org/10.1007/s00381-011-1464-3DOI Listing

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