Prediction of intracranial hypertension through noninvasive
intracranial pressure waveform analysis
in pediatric hydrocephalus
Matheus Fernando Manzolli Ballestero
Brenno Caetano Troca Cabella
Sergio Mascarenhas de Oliveira
Ricardo Santos de Oliveira
Received: 9 March 2017 /Accepted: 30 May 2017 /Published online: 16 June 2017
Springer-Verlag Berlin Heidelberg 2017
Purpose The purpose of this study is to evaluate a noninva-
sive device to assess intracranial pressure wave form in chil-
dren with hydrocephalus.
Methods A prospective and non-experimental descriptive-an-
alytic study was performed. Fifty-six patients were enrolled in
this study. They were divided in four groups: group A, chil-
dren with clinically compensated hydrocephalus; B, surgically
treated hydrocephalus; C, patients with acute intracranial hy-
pertension due to hydrocephalus; and D, children without
neurological disease (control). Data were collected through
the installation of an extracranial deformation sensor, coupled
to the children’s scalp, which allowed registration of noninva-
sive intracranial pressure curves. Parameters obtained were
analyzed: P2/P1 ratio, Bclassification P1 and P2 and P1 slope.
Results P2/P1 index and Bclassification of P1 and P2^ had a
sensitivity of 80% and specificity of 100% for predicting in-
tracranial hypertension. BP1 slope^ presented no statistical
Conclusion This study showed a useful and noninvasive
method for monitoring intracranial pressure, which was able
to indicate the intracranial hypertension in children with hy-
drocephalus and, thus, should be further investigated for clin-
Hydrocephalus (HCP) is a medical and social problem regard-
ing the impact in the individual health and socioeconomics
onus. The incidence of congenital HCP is about 4.6 to 5.9
per 100,000 live births [16, 19]. The economic charges are
about one billion per year only in the USA .
In the pediatric population, the diagnosis of shunt dysfunc-
tion is occasionally difficult because of the non-specificity of
symptoms, leading to the need of complementary exams in-
cluding brain sonography, computerized tomography, and
magnetic resonance. However, such tests only allow an indi-
rect assessment of intracranial pressure (ICP).
Invasive techniques for ICP monitoring remain the gold
standard. However, some risks of infection and hemorrhage
could be associated with this method .
The benefits of assessing noninvasive (NI) ICP reliably in
this population have also been described . The develop-
ment of accurate, NI alternatives is ongoing [2, 18, 19].
Perhaps the greatest benefit of a reliable NI technique lies in
early detection, especially in clinical condition which raised
ICP may be subtle.
Current methods for NI ICP assessment usually involve
evaluating physiological or anatomical characteristics influ-
enced by changes in ICP. There are several techniques report-
ed in the literature, but with varying degrees of diagnostic
accuracy when compared to the invasive methods .
* Matheus Fernando Manzolli Ballestero
Division of Pediatric Neurosurgery of the Department of Surgery and
Anatomy, Ribeirão Preto Medical School, University of São Paulo,
Ribeirão Preto 14049-900, São Paulo, Brazil
Institute of Advanced Studies, University of São Paulo, Sao
Carlos, Sao Paulo, Brazil
Childs Nerv Syst (2017) 33:1517–1524