Intracranial Pressure: Invasive Methods of Monitoring

Abstract

Since the discovery of a small foramen in the floor of the fourth ventricle and its connection to the subarachnoid spaces of the brain and spinal cord by François Magendie in the late eighteenth century, neurologists and neurosurgeons have studied the physiological relationships between the cerebrospinal fluid flow and the problems caused by the raising of its pressure [1], although initially the concept of cannulation of the ventricles was frowned upon, as commented by Robert Whytt in his Observations on Dropsy in the Brain, published in 1768: 'any such attempt to draw off the water, could have no other effect than to hasten death' [2]. The first to standardize the technique for lumbar puncture and measurement of the cerebrospinal fluid (CSF) pressure by connecting the lumbar puncture needle to a fine glass pipette open to atmospheric pressure was Quinke, who in 1891 published his studies on the diagnostic and therapeutic applications of diverting the fluid from the subarachnoid space of the spinal cord [1]. Later on, researchers started moving from the lumbar puncture to the direct cath-eterization of the ventricular system, the first report of an organized method of measuring intracranial pressure took place in France, 1951 by Guillaume and Janny, which consisted in the use of continuous intracranial manometry-an electromagnetic transducer to measure ventricular CSF pulses in patients with various types of intracranial lesions [3].