Studies of regional subdural pressure gradients during craniotomy

Abstract

Intracranial pressure monitoring is based on the premise that the intracranial space is one compartment without pressure differences between brain regions. To what extent the pressure within the subarachnoid space correlates with pressures in other brain regions and whether an increase in pressure within the brain substance is transmitted to the rest of the brain and to the subarachnoid and ventricular cerebrospinal fluid are debated. In this chapter we summarize and discuss four studies dealing with regional subdural pressure gradients during craniotomy. The first study refers to studies of pressure gradients between subdural ICP and pressures within the neuroaxis, including intraventricular pressure and lumbar spinal pressure. The second study refers to subdural pressure gradients within the surgical field in patients with supratentorial tumour, the third study to pressure gradients within the surgical field in patients with infratentorial tumour, and the fourth study to changes in subdural ICP during opening of dura. © 2008 Springer-Verlag.