Intracranial pressure monitoring: Indications, techniques, interpretation

Abstract

The importance of intracranial pressure (ICP) became obvious with the knowledge and understanding of the brain's anatomy and physiology. As a result, the idea of measuring and controlling ICP was first conceived in the eighteenth century. These days, invasive techniques like the insertion of external ventricular drains (EVD) or intraparenchymal monitors (IPM) represent the gold standard in measuring ICP. However, noninvasive techniques including tomography and ultrasonography have grown in importance in recent years, especially in pediatric patients. ICP monitoring in children is mostly related to traumatic brain injury, hydrocephalus, shunt-related problems, and syndromic craniosynostosis. Contrary to the wide-spread opinion, the simple determination of the mean ICP is not sufficient to determine whether therapy should be initiated or not. One of the problems when performing ICP measurement in the pediatric population is that there are no universally accepted scales for normal and abnormal values. Another problem is posed by the continuous development of the intracranial space, and thus, by modifications of the intracranial compliance during the first years of life. Therefore, the acquisition of parameters reflecting the intracranial compliance plays a significant role in the evaluation of the child's brain. These include, for example, certain pressure ranges, the pulse pressure amplitude, or the morphology of the intracranial pressure waveform. However, the interpretation of the ICP profile is demanding and requires expertise.