REVIEW ARTICLE -NEUROSURGERY GENERAL
The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal
Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. The IAP is an important physiological parameter during neurosurgical procedures (spine and brain) in the prone position. The incidence of complications arising from increased IAP, known as intra-abdominal hypertension (IAH) or abdominal compartment syndrome in critically ill patients, is high and its impact is significant. In this review, we summarize how IAP impacts the cerebrospinal venous system and the jugular venous system via two pathways.
Increased intra-abdominal pressure (IAP) is recognized as a significant contributor to organ dysfunction in many critically ill patients. Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. Under physiological conditions, values of up to 5 mmHg are considered normal in adults. However, In conditions such as obesity or pregnancy, basic IAP may range from 10 to 15 mmHg.
Implications for neurosurgical procedures
Evidence suggests that increased IAP may play an important role during neurosurgical procedures, in patients suffering from Idiopathic intracranial hypertension (IIH) or, in Traumatic Brain Injury (TBI) and during hydrocephalus therapy.
IAP measurement could provide relevant information to improve the safety of surgical procedures in spine surgery and posterior fossa surgery.
Measurement could optimize the treatment for Idiopathic intracranial hypertension (IIH), Traumatic Brain Injury (TBI), and hydrocephalus. However, more prospective research in this field is needed.
Expected studies about IAP
Dr. van Eijs, anesthesiologist at ETZ Tilburg has submitted an application to the MEC (Medical Review Ethics Committee) for a study to measure the IAP when using the IPS-system. The IPS (Inflatable Prone Support) allows for the optimal positioning of patients on air and is designed and produced by Ergotrics. The objective is to assess the difference in Intra-Abdominal Pressure (IAP) relative to the current way of prone positioning. It is measured via a urinary catheter, when the patient is in prone position.