Non-invasive assessment of intracranial pressure

C. Robba, S. Bacigaluppi, D. Cardim, J. Donnelly, A. Bertuccio, M. Czosnyka

Research output: Contribution to journalReview articlepeer-review

105 Scopus citations

Abstract

Monitoring of intracranial pressure (ICP) is invaluable in the management of neurosurgical and neurological critically ill patients. Invasive measurement of ventricular or parenchymal pressure is considered the gold standard for accurate measurement of ICP but is not always possible due to certain risks. Therefore, the availability of accurate methods to non-invasively estimate ICP has the potential to improve the management of these vulnerable patients. This review provides a comparative description of different methods for non-invasive ICP measurement. Current methods are based on changes associated with increased ICP, both morphological (assessed with magnetic resonance, computed tomography, ultrasound, and fundoscopy) and physiological (assessed with transcranial and ophthalmic Doppler, tympanometry, near-infrared spectroscopy, electroencephalography, visual-evoked potentials, and otoacoustic emissions assessment). At present, none of the non-invasive techniques alone seem suitable as a substitute for invasive monitoring. However, following the present analysis and considerations upon each technique, we propose a possible flowchart based on the combination of non-invasive techniques including those characterizing morphologic changes (e.g., repetitive US measurements of ONSD) and those characterizing physiological changes (e.g., continuous TCD). Such an integrated approach, which still needs to be validated in clinical practice, could aid in deciding whether to place an invasive monitor, or how to titrate therapy when invasive ICP measurement is contraindicated or unavailable.

Original languageEnglish (US)
Pages (from-to)4-21
Number of pages18
JournalActa Neurologica Scandinavica
Volume134
Issue number1
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Cerebral flow
  • Cerebral perfusion pressure
  • Intracranial pressure
  • Neuromonitoring
  • Non-invasive method

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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