Noninvasive Transfontanelle Monitoring of the Intracerebral Pressure in Comparison With an Invasive Intradural Intracranial Pressure Device: A Prospective Study

Background: We previously introduced a novel noninvasive technique of intracranial pressure (ICP) monitoring in children with open fontanelles.

Objective: To compare the ICP obtained by our new technique to the ICP derived from an intradurally implanted ICP measurement device (external ventricular drain, subdural ICP device).

Methods: Children with open fontanelles and need of intracranial monitoring were included in this study. A standard ICP probe was placed upon the frontal fontanelle and data were compared with the values recorded by an already invasively implanted subdural ICP technique. The 2 methods of ICP measurement were evaluated using the correlation coefficient, Bland and Altman method and method comparison by Carstensen.

Results: Five children under the age of 1 year with an open frontal fontanelle were included in this study. Three were male and 2 were female. Mean age was 7 months. A total of 139 pairs of measurements were assessed. Mean transfontanelle ICP was 7.6 mm Hg. Mean ICP measured subdurally was 5.4 mm Hg. The correlation analysis showed a correlation coefficient of 0.7. The Bland-Altman plot revealed a good accuracy of the new method with >95% of the values within the limits of agreement. An additional method comparison analysis confirmed the finding of accurate ICP measurements between both applied methods.

Conclusion: The noninvasive transfontanelle ICP monitoring method displayed a high validity and reliability as proven by correlation analysis. This novel technique might therefore be an interesting and promising tool for noninvasive ICP monitoring in children. But further research is necessary to evaluate the accuracy of this technique in children with elevated ICP.