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Posterior fossa ICP monitoring: a tale of two compartments
EANS Academy. Khan A. 09/25/19; 275573; EP08009
Amad Khan
Amad Khan

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Abstract
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Introduction: Measuring the intracranial pressure (ICP) of the infra-tentorial, posterior fossa compartment has long been avoided due to a lack of precedent and concern of damage to the brainstem. In cases of posterior fossa insults however, the supra-tentorial compartment ICPs can be falsely reassuring. We present the case of a 27 year-old male, where following resection of an acoustic neuroma, cerebellar oedema caused obstructive hydrocephalus. An external ventricular drain was inserted and showed normal ICP readings despite signs of raised pressure like bradycardia and apnoea.
Methods: An ICP monitor (Raumedic NEUROVENT-P:Parenchyma) was therefore placed intra- parenchymally into the right-sided cerebellar hemisphere to a depth of 2 cm, under direct vision during the patient´s posterior fossa decompression.
Results: The infra-tentorial compartment had ICPs averaging 11.02 +- 2.24 mmHg whilst the supra- tentorial compartment averaged 4.94 +- 1.80 mmHg in the first 72 hours post-op (p< 0.01 on paired t-testing). After 72 hours the pressures seemed to equilibrate and were 4.71+- 2.6 and 3.88 +- 2.89 for the infra and supra-tentorial compartments respectively.
Conclusion: Whilst posterior fossa ICP monitoring should be not be used routinely, it´s a useful tool to monitor patients with a posterior fossa insult because conventional supra-tentorial monitoring can be falsely reassuring.
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