Marked Increase in Intracranial Pressure With Laparoscopy: Case Report

Tovy H Kamine, MD, Efstathios Papavassiliou, MD, Benjamin E Schneider, MD. Beth Israel Deaconess Medical Center

INTRODUCTION: Diagnostic laparoscopy has recently emerged as an alternative to laparotomy in trauma patients. However, the impact of abdominal insufflation on intracranial pressure is not well described outside animal models. We present a case report of a patient who underwent a laparoscopic assisted ventriculoperitoneal shunt placement (lap VPS), with intracranial pressure (ICP) measurements.
METHODS: The patient had a lap VPS placement performed at BIDMC. Abdominal insufflation was performed using CO₂. The intracranial pressure was measured through the ventricular catheter with a simple manometer with insufflation and desufflation.
RESULTS: The patient is a 75 year old man with history of normal pressure hydrocephalus who presented for laparoscopic VP shunt placement. A Hasson trocar was placed under direct visualization and the abdomen was insufflated with CO₂ to a pressure of 15 mmHg. Concurrently, the intraventricular catheter was placed and the ICP measured to be 8-12 cm H₂O with respiratory variation. The abdomen was then desufflated and the ICP was measured to be 0-1 cm H₂O. The rest of the operation was performed without complication.
DISCUSSION: Intracranial pressure in this patient was markedly elevated with laparoscopy up to 12 cm H₂O above the desufflated baseline. Increased ICP is associated with cerebral ischemia and even herniation at levels >20mmHg. This case suggests that further research is needed on the association between laparoscopic insufflation, ICP and cerebral perfusion pressures. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.

View Poster