Abstract
Continuous monitoring of the intracranial pressure (ICP) is essential in neurocritical care. There are a variety of ICP monitoring systems currently available, with the intraventricular fluid filled catheter transducer currently representing the “gold standard”. As the placement of catheters is associated with the attendant risk of infection, hematoma formation, and seizures, there is a need for a reliable, non-invasive alternative. In the present study we suggest a unique theoretical framework based on differential geometry invariants of cranial micro-motions with the potential for continuous non-invasive ICP monitoring in conservative traumatic brain injury (TBI) treatment. As a proof of this concept, we have developed a pillow with embedded mechanical sensors and collected an extensive dataset (> 550 h on 24 TBI coma patients) of cranial micro-motions and the reference intraparenchymal ICP. From the multidimensional pulsatile curve we calculated the first Cartan curvature and constructed a ”fingerprint” image (Cartan map) associated with the cerebrospinal fluid (CSF) dynamics. The Cartan map features maxima bands corresponding to a pressure wave reflection corresponding to a detectable skull tremble. We give evidence for a statistically significant and patient-independent correlation between skull micro-motions and ICP time derivative. Our unique differential geometry-based method yields a broader and global perspective on intracranial CSF dynamics compared to rather local catheter-based measurement and has the potential for wider applications.
Highlights
Continuous monitoring of the intracranial pressure (ICP) is essential in neurocritical care
Data were manually examined and analyzed using an in-house built MATLAB code designed to seek out the longest uninterrupted segments with the minimum threshold length of 5,000 consecutive elementary intervals (EIs)
ICP monitoring is a vital part of management of pathological conditions that can result in an elevation of ICP, for example traumatic brain injury (TBI) and the associated pathophysiological mechanisms
Summary
Continuous monitoring of the intracranial pressure (ICP) is essential in neurocritical care. In the present study we suggest a unique theoretical framework based on differential geometry invariants of cranial micro-motions with the potential for continuous non-invasive ICP monitoring in conservative traumatic brain injury (TBI) treatment. Raised intracranial pressure (ICP) is a critical problem in neurosurgical and neurological practice. It can arise as a consequence of traumatic brain injury (TBI), intracranial lesions, disorders of cerebrospinal fluid (CSF) circulation and more diffuse intracranial pathological processes. The gold standard of measurement involves invasive craniotomy and insertion of a catheter, a procedure with known associated risks such as infection, hemorrhage, and tissue lesions. This remains a screening rather than a monitoring tool[5,12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
