Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2019; 7(13): 1535-1553
Published online Jul 6, 2019. doi: 10.12998/wjcc.v7.i13.1535
Intracranial pressure monitoring: Gold standard and recent innovations
Deb Sanjay Nag, Seelora Sahu, Amlan Swain, Shashi Kant
Deb Sanjay Nag, Seelora Sahu, Amlan Swain, Shashi Kant, Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
Author contributions: Nag DS, Sahu S, Swain A and Shashi Kant S were involved in conceptualization, research and drafting the review. All authors are responsible for critical revision, editing and final approval of the submitted version.
Conflict-of-interest statement: None conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Deb Sanjay Nag, MBBS, MD, Doctor, Consultant, Department of Anaesthesiology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur 831011, India. debsanjay@gmail.com
Telephone: +91-94-31166582 Fax: +91-657-2224559
Received: March 4, 2019
Peer-review started: March 8, 2019
First decision: April 18, 2019
Revised: May 11, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: July 6, 2019
Processing time: 124 Days and 7.2 Hours
Abstract

Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate non-invasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortion-product oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.

Keywords: Intracranial pressure increase; Craniocerebral trauma; Subarachnoid hemorrhages

Core tip: Although, over the last few decades, intracranial pressure monitoring (ICP) monitoring has become the standard of care, invasive methods are a health-resource intensive modality and are associated with chances of haemorrhage and infection. In terms of accuracy and reliability, the intraventricular catheter systems still remain the gold standard modality. Recent advances have led to the development of non-invasive techniques to monitor ICP, but further evidence is needed before it becomes an alternative to invasive techniques. Apart from primary brain injury due to raised ICP, secondary brain injury can occur due to ongoing micro and macro vascular dysfunction in the face of apparently normal ICP.