Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns

Abstract

Multimodality neuromonitoring represents a crucial cornerstone for patient management after acute brain injury. Despite the potential of multimodality neuromonitoring (particularly high-resolution neuromonitoring data) to transform care, its full benefits are not yet universally realized. There remains a critical need to integrate the interpretation of complex patterns and indices into the real-time clinical decision-making processes. This requires a multidisciplinary approach, to evaluate and discuss the implications of observed patterns in a timely manner, ideally in close temporal proximity to their occurrence. Such a collaborative effort could enable clinicians to harness the full potential of multimodal data. In this educational case-based scoping review, we aim to provide clinicians, researchers, and healthcare professionals with detailed, compelling examples of potential applications of multimodality neuromonitoring, focused on high-resolution modalities within the field of traumatic brain injury. This case series showcases how neuromonitoring modalities such as intracranial pressure, brain tissue oxygenation, near-infrared spectroscopy, and transcranial Doppler can be integrated with cerebral microdialysis, neuroimaging and systemic physiology monitoring. The aim is to demonstrate the value of a multimodal approach based on high-resolution data and derived indices integrated in one monitoring tool, allowing for the improvement of diagnosis, monitoring, and treatment of patients with traumatic brain injury. For this purpose, key concepts are covered, and various cases have been described to illustrate how to make the most of this advanced monitoring technology.