American Association of Neuroscience Nurses, Society of Pediatric Nurses & American Pediatric Surgical Nurses Association, Inc.

View all recommendations from this society

December 1, 2022

Don’t use lumbar puncture (LP) opening pressure as a reliable measure of intracranial pressure in children with severe chronic headache.

There are many limitations with LP pressure measurement as it varies with patient position and level of the manometer. As a “snapshot in time,” it cannot be correlated with symptoms over time, and anesthetic agents can cause false readings. An intracranial monitor (bolt) measures intracranial pressure (ICP) over time as the patient goes about daily activities. Medical and surgical treatment decisions are based on relieving intracranial pressure. Inaccurate pressure readings can lead to unnecessary surgeries such as cranial vault expansion, shunt revisions and placement of lumbar-peritoneal shunts as well as unnecessary medical treatments.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

(1–5 & 8) Members of the American Association of Neuroscience Nurses formed a task force to review evidence and make a recommendation of 5–10 things nurses should tell neuroscience patients to consider. AANN’s Special Focus Groups, which are composed of subject matter experts in various subspecialties of neuroscience, were consulted to help identify topics and provide supporting evidence. The task force reviewed the items for possible inclusion to determine the top recommendations. The top recommendations were presented to the AANN Board for review and approval.

(6) SPN initially reached out to several subject matter experts to learn about topic areas where they were aware of both evidence of overuse of health care resources and evidence-based resources to support addressing that overuse. SPN then chose two experts with research experience within the topic area we identified. One served as the main author while the other served as the reviewer. After the initial review was completed, we shared the content with the SPN Board of Directors for further input. Finally, colleagues at the American Academy of Nursing provided a final review.

(7) Once the American Pediatric Surgical Nurses Association, Inc. (APSNA) received an invitation from the Institute of Pediatric Nursing (IPN) to participate in the initiative, the APSNA Board was queried to identify pediatric nursing practices that should be modified based on evidence. The identified practice was presented to experts from APSNA’s Board of Directors, General Membership and Trauma Special Interest Group (SIG). The preliminary statement was reviewed and revised by content experts from both within and outside of the organization. Subsequently, the statement was submitted to the APSNA Board for final discussion and review. The final statement was reviewed and approved by the American Academy of Nursing.


Baird LC, Gonda D, Cohen SR, Evers LJ, LeFloch N, Levy ML, Meltzer HS. “Craniofacial reconstruction as a treatment for elevated intracranial pressure.” Child’s Nervous
System. 2012; 28(3):411-418.

Cartwright CC & Igbaseimokumo U. “Lumbar puncture opening pressure is not a reliable measure of intracranial pressure in children.” Journal of Child Neurology. 2014;

Eidlitz-Markus T, Stiebel-Kalish H, Rubin Y, Shuper A. CSF pressure measurement during anesthesia: an unreliable technique. Paediatric Anaesthesia. 2005; 15:1078-1082.

Horton CH. “Continuous intracranial pressure monitoring: a last resort in pseudotumor cerebri.” Journal of Neuro-Ophthalmology. 2011; 31:199-201.

Warden KF, Alizai AM, Trobe JD, Hoff JT. Short-term continuous intraparenchymal intracranial pressure monitoring in presumed idiopathic intracranial hypertension. Journal of Neuroophthalmology. 2011; 31:202-205.

Wiegand C & Richards P. “Measurement of intracranial pressure in children: a critical review of current methods.” Developmental Medicine and Child Neurology. 2007; 49:935-941.