Noninvasive Intracranial Pressure Monitoring: Are We There Yet?

• DOI: 10.1007/s12028-024-01951-1
• Publication Date: 2024-03-01T21:14:21Z
• Authors: Venkatakrishna Ra...
• Keywords: Guideline; Intracranial pressure monitoring; Gold standard (test); Clinical Practice

There is an urgent unmet need for a reliable noninvasive tool to detect elevations in intracranial pressure (ICP) above guideline-recommended thresholds treatment. Gold standard invasive ICP monitoring unavailable many settings, including resource-limited environments, and situations such as liver failure which coagulopathy increases the risk of monitoring. Although large number techniques have been evaluated, this article reviews potential clinical role, if any, that undergone most extensive evaluation are already use. Elevations transmitted through subarachnoid space result distension optic nerve sheath. The sheath diameter (ONSD) can be measured with ultrasound, ONSD threshold used elevated ICP. studies suggest technique accurately detects ICP, there concern bias variations across preclude routine use practice. Multiple transcranial Doppler assess but best studied pulsatility index Czosnyka method estimate cerebral perfusion inconsistency literature, recent prospective studies, international multicenter study, estimated has high negative predictive value (> 95%) poor positive (≤ 30%). Quantitative pupillometry sensitive objective pupillary size reactivity. Proprietary indices developed quantify light response. Limited data these quantitative measurements may useful early detection elevation. No current technology replace Where unavailable, multimodal assessment useful. Further innovation research required develop reliable, continuous assessment.