4cadd11801166c9c1f689caf8c40ec85 jcm-14-03042.pdf f4fdfac3f624145e4c34b7d585586552dd8253b7 jcm-14-03042.pdf 12f72a6127883747a433a319d7721cd481246450bf199a5ef84e1c501197c753 jcm-14-03042.pdf Title: Continuous Intracranial Pressure Monitoring in Children with ‘Benign’ External Hydrocephalus Subject: Background/Objectives: This study aimed to evaluate the results of continuous intracranial pressure (ICP) monitoring in children with macrocephaly or rapidly increasing head circumference (HC) diagnosed as benign external hydrocephalus (BEH). Here, we report the absolute ICP measurements, ICP pulsatility, and slow ICP waves after at least 48 h of continuous monitoring in a cohort of 36 children diagnosed with BEH. Methods: A prospective study of continuous ICP monitoring was performed in 36 consecutive children with macrocephaly (HC above the 97.5th percentile) or rapidly increasing HC (at least crossing two percentile curves), diagnosed with BEH (22 boys and 14 girls with a mean age of 23.6 13.3 months, minimum: 6, maximum 65), using an epidural sensor. For the first four children in the study, hard copies of the ICP values were obtained using an analog recorder. Starting from the fifth patient, the ICP signal was sampled at 200 Hz and stored on a computer using a computer-based data acquisition and analysis system (LabChart v8.1 software). Results: Clinical signs or symptoms were identified in 20 patients (55.6%). Delayed motor or language development was noted in 18 (50%) and 20 (55.6%) patients, respectively. In 13 patients, the enlargement of the subarachnoid spaces was found to be associated with an additional condition. The median of mean ICP values for the entire cohort was 17 mmHg, with a minimum of 6.7 mmHg and a maximum of 29 mmHg. All patients exhibited a percentage of B waves exceeding 20% during the night, with a median value of 47.4% (min: 23.2, max: 75). Three children had nocturnal plateau waves. At night, regular ICP recordings alternated with periods of significant increases in ICP, often exceeding 10 mmHg above baseline values. High-amplitude B waves were noted during these episodes, and the amplitude of the cardiac waveform at the peak of the B waves was consistently greater than 5 mmHg, displaying an abnormal morphology (P2 > P1). A ventriculoperitoneal shunt was implanted in 30 of the 36 patients. Conclusions: Patients with BEH may present significant abnormalities in ICP. Monitoring this variable in certain cases can assist in determining the necessity for surgical treatment. Keywords: benign enlargement of subarachnoid spaces; external hydrocephalus; intracranial hypertension; intracranial pressure monitoring; intracranial pressure pulsatility; macrocephaly Author: Maria A. Poca, Diego Lopez-Bermeo, Paola Cano, Federica Maruccia, Carolina Fajardo, Ignacio Delgado, Francisca Munar, Anna Garcia-Merino and Juan Sahuquillo Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Mon Apr 28 13:41:14 2025 CEST ModDate: Mon Apr 28 13:46:06 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 24 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 7925018 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- QKZKVH+VnURWPalladioL Type 1 Custom yes yes yes 10 0 AETHSN+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 XAJSKZ+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 BXTBRB+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 RHOBPE+CMSY10 Type 1 Builtin yes yes yes 32 0 BBHBFA+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 72 0 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2023-05-18) Date: 2026-03-28 04:11:53 CET RepresentationInformation: jcm-14-03042.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-27 15:41:40 CET Size: 7925018 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 638 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Patients and Methods Destination: section.2 Children: Item: Title: Ethical Statement Destination: subsection.2.1 Item: Title: Patient Selection Destination: subsection.2.2 Item: Title: Neuroimaging Studies Destination: subsection.2.3 Item: Title: Psychomotor Development Assessment Destination: subsection.2.4 Item: Title: Methodology for ICP Monitoring Destination: subsection.2.5 Item: Title: Criteria for Shunting and Postoperative Adverse Events Destination: subsection.2.6 Item: Title: Statistical Analysis Destination: subsection.2.7 Item: Title: Results Destination: section.3 Children: Item: Title: Patient Population and Symptoms Destination: subsection.3.1 Item: Title: Neuroimaging Data Destination: subsection.3.2 Item: Title: Results of Continuous ICP Monitoring Destination: subsection.3.3 Item: Title: Treatment and Complications Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Children: Item: Title: Pathophysiology of BEH: Unresolved Questions and Controversies Destination: subsection.4.1 Item: Title: Benign External Hydrocephalus: A Misleading Label Destination: subsection.4.2 Item: Title: ICP Abnormalities in Children with BEH Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: Limitations of the Study Destination: section.6 Item: Title: Future Work Destination: section.7 Item: Title: References Destination: appendix.A. Info: Title: Continuous Intracranial Pressure Monitoring in Children with ‘Benign’ External Hydrocephalus Author: Maria A. Poca, Diego Lopez-Bermeo, Paola Cano, Federica Maruccia, Carolina Fajardo, Ignacio Delgado, Francisca Munar, Anna Garcia-Merino and Juan Sahuquillo Subject: Background/Objectives: This study aimed to evaluate the results of continuous intracranial pressure (ICP) monitoring in children with macrocephaly or rapidly increasing head circumference (HC) diagnosed as benign external hydrocephalus (BEH). Here, we report the absolute ICP measurements, ICP pulsatility, and slow ICP waves after at least 48 h of continuous monitoring in a cohort of 36 children diagnosed with BEH. Methods: A prospective study of continuous ICP monitoring was performed in 36 consecutive children with macrocephaly (HC above the 97.5th percentile) or rapidly increasing HC (at least crossing two percentile curves), diagnosed with BEH (22 boys and 14 girls with a mean age of 23.6 13.3 months, minimum: 6, maximum 65), using an epidural sensor. For the first four children in the study, hard copies of the ICP values were obtained using an analog recorder. Starting from the fifth patient, the ICP signal was sampled at 200 Hz and stored on a computer using a computer-based data acquisition and analysis system (LabChart v8.1 software). Results: Clinical signs or symptoms were identified in 20 patients (55.6%). Delayed motor or language development was noted in 18 (50%) and 20 (55.6%) patients, respectively. In 13 patients, the enlargement of the subarachnoid spaces was found to be associated with an additional condition. The median of mean ICP values for the entire cohort was 17 mmHg, with a minimum of 6.7 mmHg and a maximum of 29 mmHg. All patients exhibited a percentage of B waves exceeding 20% during the night, with a median value of 47.4% (min: 23.2, max: 75). Three children had nocturnal plateau waves. At night, regular ICP recordings alternated with periods of significant increases in ICP, often exceeding 10 mmHg above baseline values. High-amplitude B waves were noted during these episodes, and the amplitude of the cardiac waveform at the peak of the B waves was consistently greater than 5 mmHg, displaying an abnormal morphology (P2 > P1). A ventriculoperitoneal shunt was implanted in 30 of the 36 patients. Conclusions: Patients with BEH may present significant abnormalities in ICP. Monitoring this variable in certain cases can assist in determining the necessity for surgical treatment. 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