Noninvasive intracranial pressure monitoring methods: a critical review

Fabiano Moulin de Moraes, Gisele Sampaio Silva, Fabiano Moulin de Moraes, Gisele Sampaio Silva

Abstract

Background: Intracranial pressure (ICP) monitoring has been used for decades in management of various neurological conditions. The gold standard for measuring ICP is a ventricular catheter connected to an external strain gauge, which is an invasive system associated with a number of complications. Despite its limitations, no noninvasive ICP monitoring (niICP) method fulfilling the technical requirements for replacing invasive techniques has yet been developed, not even in cases requiring only ICP monitoring without cerebrospinal fluid (CSF) drainage.

Objectives: Here, we review the current methods for niICP monitoring.

Methods: The different methods and approaches were grouped according to the mechanism used for detecting elevated ICP or its associated consequences.

Results: The main approaches reviewed here were: physical examination, brain imaging (magnetic resonance imaging, computed tomography), indirect ICP estimation techniques (fundoscopy, tympanic membrane displacement, skull elasticity, optic nerve sheath ultrasound), cerebral blood flow evaluation (transcranial Doppler, ophthalmic artery Doppler), metabolic changes measurements (near-infrared spectroscopy) and neurophysiological studies (electroencephalogram, visual evoked potential, otoacoustic emissions).

Conclusion: In terms of accuracy, reliability and therapeutic options, intraventricular catheter systems still remain the gold standard method. However, with advances in technology, noninvasive monitoring methods have become more relevant. Further evidence is needed before noninvasive methods for ICP monitoring or estimation become a more widespread alternative to invasive techniques.

Conflict of interest statement

Conflict of interest: There is no conflict of interest to declare.

Figures

Figure 1. Computed tomography findings in intracranial…
Figure 1. Computed tomography findings in intracranial hypertension (A) loss of cortical-subcortical differentiation and cortical subarachnoid hemorrhage. (B) temporal horn dilation and cisternal subarachnoid hemorrhage.
Figure 2. Optic nerve sheath and the…
Figure 2. Optic nerve sheath and the globe are evident. The optic nerve sheath is a linear hypoechoic structure posterior to the globe. Line 1 identifies the site of optic nerve sheath diameter measurement 0.3 cm behind the retina. Line 2 measures the optic nerve sheath diameter (0.34 cm in this case).
Figure 3. Transcranial Doppler measurement of right…
Figure 3. Transcranial Doppler measurement of right middle cerebral artery flows, demonstrating a PI of 1.26.
Figure 4. Waveform analysis. (A) Components of…
Figure 4. Waveform analysis. (A) Components of the indications for intracranial pressure waveform: pulse pressure waveform and respiratory waveform. (B) Comparison of indications for intracranial pressure waveforms obtained with an invasive sensor (iICP) and the noninvasive Brain4care® system. (C) indications for intracranial pressure waveforms measured using the Brain4care® sensor.
A: normal waveform (P1>P2). B: abnormal waveform (P2>P1). The report provides quantitative information about ICP wave morphology to assist in patient assessment and follow-up. P2/P1 ratio: the ratio between the amplitudes of peaks P2 and P1; TTP: time to peak, defined as the time, from the start of the pulse, at which the ICP waveform reaches its highest peak.

References

    1. 1. Shannon FM, Tran A, Cheng W, Rochwerg B, Taljaard M, Kyeremanteng K, et al. Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis. BMJ. 2019 Jul;366:l4225.
    1. 2. Harary M, Dolmans RGF, Gormley WB. Intracranial pressure monitoring-review and avenues for development. Sensors (Basel). 2018 Feb;18(2):465.
    1. 3. Czosnyka M, Pickard J. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):813-21.
    1. 4. Shafi S, Diaz-Arrastia R, Madden C, Gentilello L. Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma. 2008;64(2):335-40.
    1. 5. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012 Dec;367(26):2471-81.
    1. 6. Bekar A, Doğan S, Abaş F, Caner B, Korfali G, Kocaeli H, et al. Risk factors and complications of intracranial pressure monitoring with a fiberoptic device. J Clin Neurosci. 2009 Feb;16(2):236-40.
    1. 7. Kasprowicz M, Lalou DA, Czosnyka M, Garnett M, Czosnyka Z. Intracranial pressure, its components and cerebrospinal fluid pressure–volume compensation. Acta Neurol Scand. 2016 Sep;134(3):168-80.
    1. 8. Raboel PH, Bartek J, Andresen M, Bellander BM, Romne B. Intracranial pressure monitoring: Invasive versus non-invasive methods-a review. Crit Care Res Pract. 2012 Jun;2012:950393.
    1. 9. Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, et al. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas. 2017 Jul;38(8):R143-R182.
    1. 10. Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M. Non-invasive assessment of intracranial pressure. Acta Neurol Scand. 2016 Jul;134(1):4-21.
    1. 11. Pappu S, Lerma J, Khraishi T. Brain CT to assess intracranial pressure in patients with traumatic brain injury. J Neuroimaging. 2016 Jan-Feb;26(1):37-40.
    1. 12. Alperin NJ, Lee SH, Loth F, Raksin PB, Lichtor T. MR-intracranial pressure (ICP): A method to measure intracranial elastance and pressure noninvasively by means of MR imaging: baboon and human study. Radiology. 2000 Dec;217(3):877-85.
    1. 13. Marshall LF, Marshall SB, Klauber MR, van Berkum Clark M, Eisenberg H, Jane JA, et al. A new classification of head injury based on computerized tomography. J Neurosurg. 1991 Nov;75 Suppl: S1-S66.
    1. 14. Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care. 2011 Dec;15(3):506-15.
    1. 15. Hiler M, Czosnyka M, Hutchinson P, Balestreri M, Smielewski P, Matta B, et al. Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg. 2006 May;104(5):731-7.
    1. 16. Nag DS, Sahu S, Swain A, Kant S. Intracranial pressure monitoring: Gold standard and recent innovations. World J Clin Cases. 2019 Jul;7(13):1535-53.
    1. 17. Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Comparison of accuracy of optic nerve ultrasound for the detection of intracranial hypertension in the setting of acutely fluctuating vs stable intracranial pressure: Post-hoc analysis of data from a prospective, blinded single center study. Crit Care. 2012 May;16(3):R79.
    1. 18. Agrawal A, Cheng R, Tang J, Madhok DY. Comparison of two techniques to measure optic nerve sheath diameter in patients at risk for increased intracranial pressure. Crit Care Med. 2019 Jun;47(6):e495-e501.
    1. 19. Swanson JW, Aleman TS, Xu W, Ying G-S, Pan W, Liu GT, et al. Evaluation of optical coherence tomography to detect elevated intracranial pressure in children. JAMA Ophthalmol. 2017 Apr;135(4):320-8.
    1. 20. Kalantari H, Jaiswal R, Bruck I, Matari H, Ghobadi F, Weedon J, et al. Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med. 2013 Nov;31(11):1595-7.
    1. 21. Klingelhöfer J, Dander D, Holzgraefe M, Bischoff C, Conrad B. Cerebral vasospasm evaluated by transcranial doppler ultrasonography at different intracranial pressures. J Neurosurg. 1991 Nov;75(5):752-8.
    1. 22. Homburg AM, Jakobsen M, Enevoldsen E. Transcranial doppler recordings in raised intracranial pressure. Acta Neurol Scand. 1993 Jun;87(6):488-93.
    1. 23. Bellner J, Romner B, Reinstrup P, Kristiansson K-A, Ryding E, Brandt L. Transcranial doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004 Jul;62(1):45-51.
    1. 24. Wakerley BR, Kusuma Y, Yeo LL, Liang S, Kumar K, Sharma AK, et al. Usefulness of transcranial Doppler-derived cerebral hemodynamic parameters in the noninvasive assessment of intracranial pressure. J Neuroimaging. Jan- 2015 Feb;25(1):111-6.
    1. 25. Zweifel C, Czosnyka M, Carrera E, Deriva N, Pickard JD, Smielewski P. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 2012 Oct;71(4):853-61.
    1. 26. Schmidt B, Czosnyka M, Schwarze JJ, Sander D, Gerstner W, Lumenta CB, et al. Evaluation of a method for noninvasive intracranial pressure assessment during infusion studies in patients with hydrocephalus. J Neurosurg. 2000 May;92(5):793-800.
    1. 27. Cardim D, Robba C, Donnelly J, Bohdanowicz M, Schmidt B, Damian M, et al. Prospective study on noninvasive assessment of intracranial pressure in traumatic brain-injured patients: Comparison of four methods. J Neurotrauma. 2016 Apr;33(8):792-802.
    1. 28. Schoser BG, Riemenschneider N, Hansen HC. The impact of raised intracranial pressure on cerebral venous hemodynamics: a prospective venous transcranial Doppler ultrasonography study. J Neurosurg. 1999 Nov;91(5):744-9.
    1. 29. Ragauskas A, Daubaris G, Dziugys A, Azelis V, Gedrimas V. Innovative non-invasive method for absolute intracranial pressure measurement without calibration. Acta Neurochir Suppl. 2005;95:357-61.
    1. 30. Kampfl A, Pfausler B, Denchev D, Jaring HP, Schmutzhard E. Near infrared spectroscopy (NIRS) in patients with severe brain injury and elevated intracranial pressure. A pilot study. Acta Neurochir Suppl. 1997;70:112-4. .
    1. 31. Davies DJ, Su Z, Clancy MT, Lucas SJE, Dehghani H, Logan A, et al. Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review. J Neurotrauma. 2015 Jul;32(13):933-41.
    1. 32. Amantini A, Carrai R, Lori S, Peris A, Amadori A, Pinto F, Grippo A. Neurophysiological monitoring in adult and pediatric intensive care. Minerva Anestesiol. 2012 Sep;78(9):1067-75.
    1. 33. Amantini A, Fossi S, Grippo A, Innocenti P, Amadori A, Bucciardini L, et al. Continuous EEG-SEP monitoring in severe brain injury. Neurophysiol Clin. 2009 Apr;39(2):85-93.
    1. 34. Connolly M, Vespa P, Pouratian N, Gonzalez NR, Hu X. Characterization of the relationship between intracranial pressure and electroencephalographic monitoring in burst-suppressed patients. Neurocrit Care. 2015 Apr;22(2):212-20.
    1. 35. Chen H, Wang J, Mao S, Dong W, Yang H. A new method of intracranial pressure monitoring by EEG power spectrum analysis. Can J Neurol Sci. 2012 Jul;39(4):483-7.
    1. 36. Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973 Jul-Aug;4(4):674-83.
    1. 37. York D, Legan M, Benner S, Watts C. Further studies with a noninvasive method of intracranial pressure estimation. Neurosurgery. 1984 Apr;14(4):456-61.
    1. 38. Andersson L, Sjolund J, Nilsson J. Flash visual evoked potentials are unreliable as markers of ICP due to high variability in normal subjects. Acta Neurochir (Wien). 2012 Jan;154(1):121-7.
    1. 39. Marshall LF, Barba D, Toole BM, Bowers SA. The oval pupil: Clinical significance and relationship to intracranial hypertension. J Neurosurg. 1983 Apr;58(4):566-8.
    1. 40. Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: The introduction of the Neurological Pupil index. Surg Neurol Int. 2011;2:82.
    1. 41. Monro A. Observations on the structure and functions of the nervous system. Edinbourgh, UK: Creech and Johnson; 1783.
    1. 42. Kellie G. Appearances observed in the dissection of two individuals; death from cold and congestion of the brain. Trans. Med.-Chir. Soc. Edinbrugh. 1824;1: 84.
    1. 43. Cushing H. The third circulation in studies in intracranial physiology and surgery. London, UK: Oxford University Press; 1926.
    1. 44. Pitlyk PJ, Piantanida TP, Ploeger DW. Noninvasive intracranial pressure monitoring. Neurosurgery. 1985 Oct;17(4):581-4.
    1. 45. Yue LW. Deformation of skull bone as intracranial pressure changing. African J Biotechnol. 2009 Mar;8(5):745-50.
    1. 46. Vilela GH, Cabella B, Mascarenhas S, Czosnyka M, Smielewski P, Dias C, et al. Validation of a new minimally invasive intracranial pressure monitoring method by direct comparison with an invasive technique. Acta Neurochir Suppl. 2016;122:97-100.
    1. 47. Mascarenhas S, Vilela GHF, Carlotti C, Damiano LEG, Seluque W, Colli B, et al. The new ICP minimally invasive method shows that the Monro-Kellie doctrine is not valid. Acta Neurochir Suppl. 2012;114:117-20.
    1. 48. Gomes I, Shibaki J, Padua B, Silva F, Gonçalves T, Spavieri-Junior DL, et al. Comparison of Waveforms Between Noninvasive and Invasive Monitoring of Intracranial Pressure. Acta Neurochir Suppl. 2021;131:135-40.
    1. 49. Noori HR. Examples of Hysteresis Phenomena in Biology. In: Hysteresis Phenomena in Biology. Springer Briefs in Applied Sciences and Technology., Berlin, Heidelberg: Springer; 2014.
    1. 50. Bollela VR, Frigieri G, Vilar FC, Spavieri Jr DL, Tallarico FJ, Tallarico GM, et al. Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis. Braz J Med Biol Res. 2017 Aug;50(9):e6392.
    1. 51. Ballestero MFM, Frigieri G, Cabella BCT, de Oliveira SM, de Oliveira RS. Prediction of intracranial hypertension through noninvasive intracranial pressure waveform analysis in pediatric hydrocephalus. Childs Nerv Syst. 2017 Sep;33(9):1517-24.
    1. 52. Frigieri G, Andrade RAP, Dias C, Spavieri Jr DL, Brunelli R, Cardim DA, et al. Analysis of a Non-invasive intracranial pressure monitoring method in patients with traumatic brain injury. Acta Neurochir Suppl. 2018;126:107-10.
    1. 53. Golzan SM, Avolio A, Graham SL. Hemodynamic interactions in the eye: a review. Ophthalmologica. 2012 Oct;228(4):214-21.
    1. 54. Firsching R, Schütze M, Motschmann M, Behrens-Baumann W. Venous opthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J Neurosurg. 2000 Jul;93(1):33-6.
    1. 55. Firsching R, Müller C, Pauli SU, Voellger B, Röhl FW, Behrens-Baumann W. Noninvasive assessment of intracranial pressure with venous ophthalmodynamometry. Clinical article. J Neurosurg. 2011 Aug;115(2):371-4.
    1. 56. Marchbanks RJ. Measurement of tympanic membrane displacement arising from aural cardiovascular activity, swallowing, and intra-aural muscle reflex. Acta Otolaryngol. Jul-Aug 1984;98(1-2):119-29.
    1. 57. Reid A, Marchbanks RJ, Burge DM, Martin AM, Bateman DE, Pickard JD, et al. The relationship between intracranial pressure and tympanic membrane displacement. Br J Audiol. 1990 Apr;24(2):123-9.
    1. 58. Samuel M, Burge DM, Marchbanks RJ. Tympanic membrane displacement testing in regular assessment of intracranial pressure in eight children with shunted hydrocephalus. J Neurosurg. 1998 Jun;88(6):983-95.
    1. 59. Bershad EM, Urfy MZ, Pechacek A, McGrath M, Calvillo E, Horton NJ, et al. Intracranial pressure modulates distortion product otoacoustic emissions: a proof-of-principle study. Neurosurgery. 2014 Oct;75(4):445-54; discussion 454-5.
    1. 60. Voss SE, Horton NJ, Tabucchi TH, Folowosele FO, Shera CA. Posture-induced changes in distortionproduct otoacoustic emissions and the potential for noninvasive monitoring of changes in intracranial pressure. Neurocrit Care. 2006 Jun;4(3):251-7.
    1. 61. Buki B, Avan P, Lemaire JJ, Dordain M, Chazal J, Ribari O. Otoacoustic emissions: a new tool for monitoring intracranial pressure changes through stapes displacements. Hear Res 1996;2:125-39.
    1. 62. Michaeli D, Rappaport ZH. Tissue resonance analysis; a novel method for noninvasive monitoring of intracranial pressure. Technical note. J Neurosurg. 2002 Jun;96(6):1132-7.
    1. 63. Wu J, He W, Chen WM, Zhu L. Research on simulation and experiment of noninvasive intracranial pressure monitoring based on acoustoelasticity effects. Med Devices (Auckl). 2013 Aug;6:123-31.
    1. 64. Bunegin L, Albin MS, Rauschhuber R, Marlin AE. Intracranial pressure measurement from the anterior fontanelle utilizing a pneumoelectronic switch. Neurosurgery. 1987 May;20(5):726-31.
    1. 65. Horbar JD, Yeager S, Philip AG, Lucey JF. Effect of application force on noninvasive measurements of intracranial pressure. Pediatrics. 1980 Sep;66(3):455-7.
    1. 66. Wiegand C, Richards P. Measurement of intracranial pressure in children: a critical review of current methods. Dev Med Child Neurol. 2007 Dec;49(12):935-41.
    1. 67. Sheeran P, Bland JM, Hall GM. Intraocular pressure changes and alterations in intracranial pressure. Lancet. 2000 Mar;355(9207):899.
    1. 68. Sajjadi SA, Harirchian MH, Sheikhbahaei N, Mohebbi MR, Malekmadani MH, Saberi H. The relation between intracranial and intraocular pressures: study of 50 patients. Ann Neurol. 2006 May;59(5):867-70.
    1. 69. Li Z, Yang Y, Lu Y, Liu D, Xu E, Jia J, et al. Intraocular pressure vs intracranial pressure in disease conditions: a prospective cohort study (Beijing iCOP study). BMC Neurol. 2012 Aug;12:66.
    1. 70. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S1-106.

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