David S. Xu, Randall J. Hlubek, Celene B. Mulholland, Kerry L. Knievel, Kris A. Smith, Peter Nakaji

The diagnosis and management of patients with idiopathic intracranial hypertension (IIH) frequently relies on lumbar puncture to ascertain intracranial pressures. However, pressures derived this way may be spurious due to patient body habitus and behavior. We recently incorporated direct continuous intracranial pressure (ICP) monitoring into the work-up for IIH and review our experience and outcomes. Through billing records, we identified all patients during a 3-year period who had a diagnosis of idiopathic intracranial hypertension and who underwent ICP monitoring prior to shunt placement or revision. Patient demographics and clinical data were reviewed. Thirty patients underwent intracranial ICP monitoring with an intraparenchymal wire; 17 of those had undergone lumbar puncture within the previous 6 months. from lumbar punctures showed an elevated opening pressure in all 17 patients, whereas only 2 patients (12%) were found to have consistently elevated ICP with direct ICP monitoring. Of 15 patients being evaluated for shunting, 4 (27%) were found to have elevated ICP. Of the 15 patients with existing shunts, 2 patients (13%) were found to have malfunctioning shunts after pressure monitoring, and 3 patients (20%) had shunts that were found to be unnecessary and were removed. No patient experienced any complication from invasive monitoring. Intracranial monitoring is the gold standard for determining ICP and can be safely and effectively applied to the work-up and treatment of IIH patients to reduce the occurrence of misdiagnosis and unnecessary surgery.