The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography

Background. This study explored whether assessment of the cerebral ventricular size (or changes in size) by cranial computed tomography (CT) is a reliable way to predict the intracranial pressure (ICP). Methods. A total of 224 cranial CT scans and continuous 24 hours ICP recordings in 184 patients were examined and compared. In these cases examinations were undertaken on the basis of suspected craniosynostosis, hydrocephalus or extracranial shunt failure. Simultaneous CT scanning and ICP monitoring was performed twice in 31 cases. Various measures of cerebral ventricular size were computed on the basis of CT, including Evan's index, third ventricular index, cella media index and ventricular score. Various measures of ICP were computed by means of the software Sensometrics(TM) Pressure Analyser, including computation of mean ICP, numbers of ICP elevations (20-30 mmHg lasting either 0.5, 1, 5 or 10 minutes), and numbers of ICP depressions (-5 or -10 mmHg lasting either 0.5, 1, 5 or 10 minutes) during a standardized recording time of 10 hours. The relationships between the various measures of ventricular size and the various measures of ICP were explored. Findings. There was a weak and non-significant relationship between the various measures of ventricular size and the measures of ICP in the 184 cases. There was a weak relationship between changes in size of cerebral ventricles and changes in ICP in the 31 cases examined twice. Interpretation. The present results suggest that actual size or changes in size of the cerebral ventricles were no reliable predictors of ICP or changes in ICP, suggesting that great caution should be exercised when predicting ICP on the basis of the size of the cerebral ventricles on cranial CT scanning.