Invasive and noninvasive means of measuring intracranial pressure: a review.

摘要: Measurement of intracranial pressure (ICP) can be invaluable in the management critically ill patients. Cerebrospinal fluid is produced by choroid plexus brain ventricles (a set communicating chambers), after which it circulates through different and exits into subarachnoid space around brain, where reabsorbed venous system. If does not drain out or get reabsorbed, ICP increases, may lead to damage death. elevation accompanied dilatation cerebral termed hydrocephalus, whereas normal small idiopathic hypertension. Objective We performed a comprehensive literature review on how measure invasively noninvasively. Approach This discusses advantages disadvantages current invasive noninvasive approaches. Main results Invasive methods remain most accurate at measuring ICP, but they are prone variety complications including infection, hemorrhage neurological deficits. Ventricular catheters gold standard also carry highest risk complications, difficult incorrect placement. Direct telemetric intraparenchymal monitoring devices good alternative. Noninvasive for evaluating have been developed classified five broad categories, reliable enough use routine basis. These include dynamic, ophthalmic, otic, electrophysiologic methods, as well magnetic resonance imaging, transcranial Doppler ultrasonography (TCD), blood flow velocity, near-infrared spectroscopy, time-of-flight, spontaneous pulsations, ophthalmodynamometry, optical coherence tomography retina, optic nerve sheath diameter (ONSD) assessment, pupillometry constriction, sensing tympanic membrane displacement, analyzing otoacoustic emissions/acoustic measure, acoustic signals, visual-evoked potentials, electroencephalography, skull vibrations, tissue jugular vein. Significance provides perspective measurements, along with sense their relative strengths, drawbacks areas further improvement. At present, none demonstrates sufficient accuracy ease while allowing continuous clinical use. However, provide realizable measurement specific patients especially when contraindicated unavailable. Among all ONSD TCD attractive useful selected settings though cannot used substitutes. For sufficiently universal method/device, future research developments needed integrate refinements existing combine sensors and/or technologies, validate large numbers studies relevant patient populations.