A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage.

Hypertensive cerebral hemorrhage, the most common prevalent of spontaneous cerebral hemorrhage, poses a significant threat to patient mortality and morbidity, while therapeutic options remain limited, making the disease a burden not only for patients' families but also a major challenge for national healthcare systems. The elevation of intracranial pressure subsequent to hypertensive cerebral hemorrhage is a critical contributor to mortality. However, it often manifests before the onset of clinical symptoms, which are typically atypical, leading to delayed treatment and irreversible consequences for the patient. Hence, early detection of intracranial pressure variations can aid in timely, efficient, and precise treatment, reducing patient mortality. Invasive intracranial pressure monitoring enables real-time, accurate monitoring of intracranial pressure changes, providing clinicians with therapeutic guidance and overcoming the limitations of empirical treatment. This article aims to review the use of invasive intracranial pressure monitoring in postoperative hypertensive cerebral hemorrhage and hopes to contribute to clinical and scientific research.

Study on application value of invasive intracranial pressure monitoring in children with severe craniocerebral trauma / 重庆医学

Objective To explore the application value of invasive intracranial pressure (ICP) monitoring in children with severe traumatic brain injur (sTBI).Methods A total of 158 children with sTBI in our hospital from January 2012 to March 2015 were collected and retrospectively analysed.According to whether the child recieved invasive ICP monitoring or not,they were divided into the monitoring group (80 cases) and the control group (78 cases).Children in the monitoring group were embed of invasive ICP monitoring device within first 24 h after surgery,and were treated with appropriate measures according to the ICP level.In the control group,the determination of whether needing to recieve head CT and adjusting the treatment program was made based on the clinical symptoms and surgeon′s experiences.The prognosis of children in the two groups were evaluated by Glasgow coma scale (GOS) and compared at 3 months after injury.At the same time,the prognosis of children in the monitoring group with different ICP levels were compared.Results The favorable prognosis rates in the monitoring group and control group were 61.2% and 41.0% respectively,and there was statistically significant difference between the two groups(P<0.05).The mortality rates of children in the monitoring group had statistical difference among different ICP levels(P<0.05).Conclusion For children with sTBI,the invasive ICP monitoring is contribute to dynamically observing the changes in ICP,early detecting changes of conditions,guiding clinical treatment,and improving the prognosis.

Comparison of intracranial pressure monitoring and routine monitoring in treatment of severe craniocerebral trauma / 局解手术学杂志

Objective To retrospectively analyze the significance of dynamic intracranial pressure monitoring and routine monitoring in the treatment of severe traumatic brain injury.Methods Forty-two patients with severe craniocerebral trauma who were admitted into our hospital from March 2013 to December 2015 and underwent intracranial pressure monitoring were enrolled in this study as the observation group.Thirty-nine patients with severe traumatic brain injury who were routinely monitored within 3 hours after admission were selected as the control group in the corresponding period.Timely take drugs or surgical treatment according to the monitoring results,and analyzed the clinical efficacy,craniotomy cases,time of admission to craniotomy,and complications of the two groups.Results The cases with good prognosis in the control group was 24 (61.5％) while it was 31 (73.8％) in the observation group,and the difference was statistically significant (P ＜ 0.05).The cases with poor prognosis in the control group was 15 (38.5％) while it was 11 (26.2％) in the observation group,and the difference was statistically significant(P ＜0.05).Therer were 13 cases (30.1％) of craniotomy in the control group and 5 cases (12.8％) in the observation group with statistically significant difference (P ＜ 0.05).The time of admission to craniotomy in the control group was (24.5 ± 1.7) hours,and it was (18.3 ± 2.4) house in the observation group with statistically significant difference (P ＜ 0.05).The incidence of intracranial infection complication was 9.5％ in the control group and 8％ in the observation group.There was no significant difference between the two groups (P ＞ 0.05).Conclusion Invasive intracranial pressure monitoring can reflect the changes of patients in time,which can improve the clinical curative effect and would not increase the incidence of intracranial infection.

Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible?

Although intracranial pressure (ICP) is essential to guide management of patients suffering from acute brain diseases, this signal is often neglected outside the neurocritical care environment. This is mainly attributed to the intrinsic risks of the available invasive techniques, which have prevented ICP monitoring in many conditions affecting the intracranial homeostasis, from mild traumatic brain injury to liver encephalopathy. In such scenario, methods for non-invasive monitoring of ICP (nICP) could improve clinical management of these conditions. A review of the literature was performed on PUBMED using the search keywords 'Transcranial Doppler non-invasive intracranial pressure.' Transcranial Doppler (TCD) is a technique primarily aimed at assessing the cerebrovascular dynamics through the cerebral blood flow velocity (FV). Its applicability for nICP assessment emerged from observation that some TCD-derived parameters change during increase of ICP, such as the shape of FV pulse waveform or pulsatility index. Methods were grouped as: based on TCD pulsatility index; aimed at non-invasive estimation of cerebral perfusion pressure and model-based methods. Published studies present with different accuracies, with prediction abilities (AUCs) for detection of ICP ≥20 mmHg ranging from 0.62 to 0.92. This discrepancy could result from inconsistent assessment measures and application in different conditions, from traumatic brain injury to hydrocephalus and stroke. Most of the reports stress a potential advantage of TCD as it provides the possibility to monitor changes of ICP in time. Overall accuracy for TCD-based methods ranges around ±12 mmHg, with a great potential of tracing dynamical changes of ICP in time, particularly those of vasogenic nature.