Abstract

Intracranial pressure (ICP) monitoring has been used for decades in management of various neurological conditions. The gold standard for measuring ICP is a ventricular catheter connected to an external strain gauge, which is an invasive system associated with a number of complications. Despite its limitations, no noninvasive ICP monitoring (niICP) method fulfilling the technical requirements for replacing invasive techniques has yet been developed, not even in cases requiring only ICP monitoring without cerebrospinal fluid (CSF) drainage. Here, we review the current methods for niICP monitoring. The different methods and approaches were grouped according to the mechanism used for detecting elevated ICP or its associated consequences. The main approaches reviewed here were: physical examination, brain imaging (magnetic resonance imaging, computed tomography), indirect ICP estimation techniques (fundoscopy, tympanic membrane displacement, skull elasticity, optic nerve sheath ultrasound), cerebral blood flow evaluation (transcranial Doppler, ophthalmic artery Doppler), metabolic changes measurements (near-infrared spectroscopy) and neurophysiological studies (electroencephalogram, visual evoked potential, otoacoustic emissions). In terms of accuracy, reliability and therapeutic options, intraventricular catheter systems still remain the gold standard method. However, with advances in technology, noninvasive monitoring methods have become more relevant. Further evidence is needed before noninvasive methods for ICP monitoring or estimation become a more widespread alternative to invasive techniques.

Highlights

  • Intracranial pressure (ICP) monitoring has been used for decades in management of various neurological conditions (Table 1) and has become a staple of neurocritical care[1]

  • The only randomized trial assessing the effect of invasive ICP monitoring on clinical outcomes, conducted by Chesnut et al.[5] among patients with severe traumatic brain injury (TBI), found that there was no significant difference in six-month mortality

  • Despite its limitations, no noninvasive ICP monitoring method fulfilling the technical requirements for replacing invasive techniques has yet been developed, not even in cases requiring only ICP monitoring without cerebrospinal fluid (CSF) drainage[8,9]

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Summary

Introduction

Intracranial pressure (ICP) monitoring has been used for decades in management of various neurological conditions (Table 1) and has become a staple of neurocritical care[1]. The only randomized trial assessing the effect of invasive ICP monitoring on clinical outcomes, conducted by Chesnut et al.[5] among patients with severe TBI, found that there was no significant difference in six-month mortality. A ventricular catheter connected to an external strain gauge is the gold standard for measuring ICP This is an invasive system associated with a number of complications, including hemorrhage, obstruction, mispositioning, infection and loss of accuracy for asymmetric hemispheric lesions, besides requiring a neurosurgical procedure[6,7]. The gold standard for measuring ICP is a ventricular catheter connected to an external strain gauge, which is an invasive system associated with a number of complications. Further evidence is needed before noninvasive methods for ICP monitoring or estimation become a more widespread alternative to invasive techniques

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