The use of noninvasive measurements of intracranial pressure in patients with traumatic brain injury: a narrative review

Abstract

Background The most frequent cause of death in neurosurgical patients is due to the increase in intracranial pressure (ICP); consequently, adequate monitoring of this parameter is extremely important. Objectives In this study, we aimed to analyze the accuracy of noninvasive measurement methods for intracranial hypertension (IH) in patients with traumatic brain injury (TBI). Methods The data were obtained from the PubMed database, using the following terms: intracranial pressure, noninvasive, monitoring, assessment, and measurement. The selected articles date from 1980 to 2021, all of which were observational studies or clinical trials, in English and specifying ICP measurement in TBI. At the end of the selection, 21 articles were included in this review. Results The optic nerve sheath diameter (ONSD), pupillometry, transcranial doppler (TCD), multimodal combination, brain compliance using ICP waveform (ICPW), HeadSense, and Visual flash evoked pressure (FVEP) were analyzed. Pupillometry was not found to correlate with ICP, while HeadSense monitor and the FVEP method appear to have good correlation, but sensitivity and specificity data are not available. The ONSD and TCD methods showed good-to-moderate accuracy on invasive ICP values and potential to detect IH in most studies. Furthermore, multimodal combination may reduce the error possibility related to each technique. Finally, ICPW showed good accuracy to ICP values, but this analysis included TBI and non-TBI patients in the same sample. Conclusions Noninvasive ICP monitoring methods may be used in the near future to guide TBI patients' management.

Brain injury mobile diagnostic system: Applications in civilian medical service and on the battlefield—General concept and medical aspects

“…In general, two methods of assessing intracranial pressure by ultrasound are possible: Examination of blood flow resistance parameters in the MCA 5,6 Measurement of the optic nerve sheath diameter using optic nerve sonography 7–9 …”

“…Examination of blood flow resistance parameters in the MCA. 5,6 2. Measurement of the optic nerve sheath diameter using optic nerve sonography.…”

“…Measurement of the optic nerve sheath diameter using optic nerve sonography. [7][8][9] An analysis of the literature indicates that measuring the blood flow in the MCA by ultrasound is more reliable 5,6 ; additionally, it allows other diagnostic tasks to be carried out using exact measurements of the blood flow through the main cerebral arteries (especially the M1 segment of the MCA).…”

“…However, the possibility that both systems could be successfully used in the MDS should not be excluded, as multimodal combinations may reduce the possibility of error related to each technique. [5][6][7][8][9] 2.3 | Robotic systems that identify blood flow in the middle cerebral artery…”