Morphological characterization of cardiac induced intracranial pressure (ICP) waves in patients with overdrainage of cerebrospinal fluid and negative ICP

Symptomatic overdrainage of cerebrospinal fluid (CSF) can be seen in shunted hydrocephalus patients and in non-shunted patients with spontaneous intracranial hypotension (SIH). In these patients, intracranial pressure (ICP) monitoring often reveals negative static ICP, while it is less understood how the pulsatile ICP (cardiac induced ICP waves) is affected. This latter aspect is addressed in the present study. A set of 40 ICP recordings from paediatric and adult hydrocephalus patients were randomly selected. Each cardiac induced ICP wave was automatically identified and manually verified by the beginning and ending diastolic minimum pressures and the systolic maximum pressure. The ICP wave parameters (static pressure, amplitude, rise time, rise time coefficient, downward coefficient, wave duration, and area-under-curve) were then automatically computed. The material of 40 ICP recordings provided a total of 3,192,166 cardiac induced ICP waves (1,292,522 in paediatric patients and 1,899,644 in adult patients). No apparent changes in ICP wave parameters were seen when mean ICP became negative, except that the parameters amplitude, rise time coefficient, downward coefficient and area under curve somewhat increased when mean ICP was below −15 mmHg.