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Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours

Orlando R. Hung, MD^*, Gregory M.T. Hare, MD PhD^* and Susan Brien, MD

^* From the Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada and the
Department of Neurosurgery, Hotel-Dieu Grace Hospital, Windsor, Ontario, Canada.

Address correspondence to: Dr. Orlando R. Hung, Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, VG Site, Halifax, Nova Scotia, B3H 2Y9 Canada. Phone: 902-473-7767; Fax: 902-423-9454; E-mail hungorla{at}is.dal.ca

Purpose: To quantify the effects of graded head rotation and elevation on intracranial pressure (ICP) in neurosurgical patients, before and after induction of general anesthesia.

Methods: Patients with supratentorial tumours (n=12), scheduled for craniotomy with planned ICP monitoring, underwent baseline ICP measurements awake and supine (0° rotation and elevation). Incremental degrees of head rotation (15°) and of head elevation (10°) were performed independently and in combination. Paired measurements of ICP at all levels of head rotation and elevation were also performed before and after induction of general anesthesia (n=6).

Results: The baseline ICP was 12.3 ± 6.4 mmHg (n=12). Changes of ICP were proportional to the degree of head rotation or elevation. Head rotation of 60° maximally increased ICP to 24.8 ± 14.3 mmHg (P < 0.05). Head elevation above 20° reduced ICP, with a maximal reduction to -0.2 ± 5.5 mmHg at 40° elevation (P < 0.01). Head elevation to 30° reduced the intracranial hypertension associated with head rotation. No differences were observed between ICP measurements made before or after induction of general anesthesia (n=6). Three patients experienced headache with extreme head rotation (<60°) and intracranial hypertension (ICP > 20 mmHg).

Conclusion: Head rotation of 60° caused an increase in ICP. Concomitant head elevation to 30° reduced the intracranial hypertension associated with head rotation. Headache with head rotation may provide a useful clinical warning of elevated ICP.

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