Subdural Intracranial Pressure in Children

Studies of ICP in adult supine-positioned patients with supratentorial tumours or prone-positioned patients with infratentorial tumours suggest a dependency of both tactile estimate of dural tension and the degree of brain swelling after opening of dura on subdural ICP monitored immediately before opening of dura. However, comparative studies of ICP and the degree of cerebral swelling during craniotomy for space-occupying lesions in children are not available. The pressure/volume relationship in children is different from that in adults because of the smaller intracranial volume and the compliancy of the cranial vault. In this chapter data on children in supine and prone positions during surgery are discussed, the influence of the anaesthetic technique, either propofol-fentanyl or isoflurane-nitrous oxide 50%-fentanyl, is disclosed and the ICP-lowering effect of reverse Trendelenburg position are presented.