Monitoring of Intracranial Pressure and Cerebral Compliance

  • G. Citerio
  • I. Piper


Traumatic brain injury (TBI) is a common form of trauma. For example, in the UK, head injury occurs in more than 500,000 persons per annum of which about 10% are diagnosed as severe, 15% moderate, and the remainder as minor, head injury [1, 2]. Head trauma is a significant cause of death and disability, especially in young males (median age < 30) and is associated with raised intracranial pressure (ICP). Raised ICP is defined as pressure greater than 20 mmHg and appears most commonly in the more than 50% of patients with severe head injury who remain comatose after resuscitation. These features have been confirmed in a recent Italian prospective data collection on patients with severe head injury admitted to intensive care [3]. In this study, the most frequent intracranial complications were raised ICP (defined as ICP > 20 mmHg for at least 15 minutes, 69%), and intractable ICP (defined as ICP > 30 mmHg for more than 30 minutes despite maximal therapy, 33%).


Traumatic Brain Injury Head Injury Intracranial Pressure Severe Head Injury Intracranial Compliance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Miller JD, Jones PA, Dearden NM, Tocher JL (1992) Progress in the management of head injury. Br J Surg 79: 60–64PubMedCrossRefGoogle Scholar
  2. 2.
    Pickard JD, Czosnyka M (1993) Management of raised intracranial pressure. J Neurol Neurosurg Psychiatry 56: 845–858PubMedCrossRefGoogle Scholar
  3. 3.
    Citerio G, Stocchetti N, Cormio M, Beretta L (2000) Neuro-Link, a computer-assisted database for head injury in intensive care. Acta Neurochir (Wien) 142: 769–776CrossRefGoogle Scholar
  4. 4.
    Becker DP, Miller JD, Ward JD, et al (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47: 491–502PubMedCrossRefGoogle Scholar
  5. 5.
    Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head inuries. Part 1: The significance of intracranial pressure monitoring. J Neurosurg 50: 20–25PubMedCrossRefGoogle Scholar
  6. 6.
    Miller JD, Becker DP, Ward JD, et al (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47: 503–516PubMedCrossRefGoogle Scholar
  7. 7.
    Pitts LH, Kaktis JV, Juster R, Heilbrun D (1980) ICP and outcome in patients with severe head injury. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Brock M (eds) Intracranial Pressure IV. Springer, Heidelberg, pp 5–9CrossRefGoogle Scholar
  8. 8.
    Eisenberg HM, Gary HE Jr, Aldrich EF, et al (1990) Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73: 688–698PubMedCrossRefGoogle Scholar
  9. 9.
    Miller JD, Butterworth JE, Gudeman SK, et al (1981) Further experience in the management of severe head injury. J Neurosurg 54: 289–299PubMedCrossRefGoogle Scholar
  10. 10.
    Narayan RK, Kishore PRS, Becker DP, et al (1982) Intracranial pressure: to monitor or not to monitor: a review of our experience with severe head injury. J Neurosurg 56: 650–659PubMedCrossRefGoogle Scholar
  11. 11.
    Saul TG, Ducker TB (1982) Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56: 498–503PubMedCrossRefGoogle Scholar
  12. 12.
    Marmarou A, Anderson RL, Ward JD, et al (1991) Impact of ICP instability on outcome in patients with severe head trauma. J Neurosurg 75 (suppl 5): s59 - s66Google Scholar
  13. 13.
    Jones PA, Andrews PJD, Midgley S, et al (1994) Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anaesth 6: 4–14Google Scholar
  14. 14.
    Stocchetti N, Rossi S, Buzzi F, et al (1999) Intracranial hypertension in head injury: management and results. Intensive Care Med 25: 371–376PubMedCrossRefGoogle Scholar
  15. 15.
    Bullock R, Chesnut RM, Clifton G, et al (1996) Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. J Neurotrauma 1996 13: 641–734Google Scholar
  16. 16.
    Masserman JH (1935) Intracranial hydrodynamics: Central nervous system shock and edema following rapid fluid decompression of ventriculo-subarachnoid spaces. J Nery Ment Dis 80: 138–158Google Scholar
  17. 17.
    Stern WE (1963) Intracranial fluid dynamics. The relationship of intracranial pressure to the Monro-Kellie doctrine and the reliability of pressure assessment. J R Coll Surg Edinb 9: 18–36Google Scholar
  18. 18.
    Langfitt TW, Weinstein JD, Kassell NF, Simeone FA (1964) Transmission of increased intra-cranial pressure I: within the craniospinal axis. J Neurosurg 21: 989–997PubMedCrossRefGoogle Scholar
  19. 19.
    Monro A (1783) Observations on the Structure and Function of the Nervous System. Creech and Johnston, EdinburghGoogle Scholar
  20. 20.
    Kellie G (1824) An account of the appearances observed in the dissection of two of three individuals presumed to have perished in the storm of the third and whose bodies were discovered in the vicinity of Leith on the morning of the 4th, November 1821, with some reflections on the pathology of the brain. Trans Med Chir Soc Edinb 1: 84–169Google Scholar
  21. 21.
    Burrows G (1846) On Disorders of the Cerebral Circulation and on the Connection between Affections of the Brain and Diseases of the Heart. Longmans, LondonGoogle Scholar
  22. 22.
    Weed LH, McKibben PS (1919) Pressure changes in cerebrospinal fluid following intravenous injection of solutions of various concentrations. Am J Physiol 48: 512–530Google Scholar
  23. 23.
    Weed LH (1929) Some limitations of the Monro-Kellie hypothesis. Arch Surg 18: 1049–1068CrossRefGoogle Scholar
  24. 24.
    Cushing H (1901) Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression. Johns Hopkins Hospital Bulletin 12: 290–292Google Scholar
  25. 25.
    Cushing H (1902) Some experimental and clinical observations concerning states of increased intracranial tension. Am J Med Sci 124: 375–400CrossRefGoogle Scholar
  26. 26.
    Cushing H (1903) The blood pressure reaction of acute cerebral compression, illustrated by cases of intracranial haemorrhage. Am J Med Sci 125: 1017–1044CrossRefGoogle Scholar
  27. 27.
    Jennet WB (1961) Experimental brain compression. Arch Neurol 4: 599–607CrossRefGoogle Scholar
  28. 28.
    Johnston IH, Rowan JO (1974) Raised intracranial pressure and cerebral blood flow: 3. Venous outflow tract pressures and vascular resistances in experimental intracranial hypertension. J Neurol Neurosurg Psychiatry 37: 392–402PubMedCrossRefGoogle Scholar
  29. 29.
    Browder J, Meyers R (1936) Observations on behavior of the systemic blood pressure, pulse and spinal fluid pressure following craniocerebral injury. Am J Surg 31: 403–427CrossRefGoogle Scholar
  30. 30.
    Smyth CE, Henderson WR (1938) Observations on the cerebrospinal fluid pressure on simultaneous ventricular and lumbar punctures. J Neurol Psychiatry 1: 226–237PubMedCrossRefGoogle Scholar
  31. 31.
    Evans JP, Espey FF, Kristoff FV, Kimball FD, Ryder HW (1951) Experimental and clinical observations on rising intracranial pressure. Arch Surg 63: 107–114CrossRefGoogle Scholar
  32. 32.
    Ryder HW, Espey FF, Kristoff FV, Evans PP (1951) Observations on the interrelationships of intracranial pressure and cerebral blood flow. J Neurosurg 8: 46–58PubMedCrossRefGoogle Scholar
  33. 33.
    Ryder HW, Espey FF, Kimbell FD, et al (1953) The elasticity of the craniospinal venous bed. J Lab Clin Med 42: 944Google Scholar
  34. 34.
    Bayliss WM, Hill L, Gulland GL (1895) On intracranial pressure and the cerebral circulation. J Physiol 18: 334–362PubMedGoogle Scholar
  35. 35.
    Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (suppl): 149Google Scholar
  36. 36.
    Lundberg N, Troupp H, Lorin H (1965) Continuous recording of the ventricular fluid pressure in patients with severe acute traumatic brain injury. J Neurosurg 22: 581–590PubMedCrossRefGoogle Scholar
  37. 37.
    Johnston IH, Johnston JJ, Jennett WB (1970) Intracranial pressures following head injury. Lancet 2: 433–436PubMedCrossRefGoogle Scholar
  38. 38.
    Richardson A, Hide TAH, Eversden ID (1970) Long-term continuous intracranial pressure monitoring by means of a modified subdural pressure transducer. Lancet 2: 687–689PubMedCrossRefGoogle Scholar
  39. 39.
    Langfitt TW, Kumar VS, James HE, Miller JD (1974) Continuous recording of intracranial pressure in patients with hypoxic brain damage. In: Brierley JS, Meldrum BS (eds) Brain Hypoxia. Heinemann, London, pp 118–135Google Scholar
  40. 40.
    Johnston IH, Paterson A (1972) Benign intracranial hypertension: aspects of diagnosis and treatment. In: Cant J S (ed) Optic Nerve. Himpton, London, pp 155–165Google Scholar
  41. 41.
    Marmarou A (1973) A theoretical and experimental evaluation of the cerebrospinal fluid system. PhD Thesis, Drexel UniversityGoogle Scholar
  42. 42.
    Marmarou A, Shulman K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43: 523–534PubMedCrossRefGoogle Scholar
  43. 43.
    Shapiro K, Fried A, Takai F, Kohn I (1985) Effect of the skull and dura on neural axis pressure-volume relationships and CSF hydrodynamics. J Neurosurg 63: 75–81Google Scholar
  44. 44.
    Shapiro K, Marmarou A (1982) Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg 56: 819–825PubMedCrossRefGoogle Scholar
  45. 45.
    Maset AL, Marmarou A, Ward JD, et al (1987) Pressure-volume index in head injury. J Neurosurg 67: 832–840PubMedCrossRefGoogle Scholar
  46. 46.
    Tans JT, Poortvliet DC (1983) Intracranial volume-pressure relationship in man. Part 2: Clinical significance of the pressure-volume index. J Neurosurg 59: 810–816PubMedCrossRefGoogle Scholar
  47. 47.
    Dayson H (1967) Physiology of the Cerebrospinal Fluid. Churchill, LondonGoogle Scholar
  48. 48.
    Marmarou A, Maset AL, Ward JD, et al (1987) Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients. J Neurosurg 66: 883–890PubMedCrossRefGoogle Scholar
  49. 49.
    Piper IR, Spiegelberg A, Bernardo A, et al (1997): A comparative study of the Spiegelberg Compliance Device with a manual volume injection method: A Clinical Evaluation. In: Proceedings of the 10th International Symposium on Intracranial pressure and Neuromonitoring, Williamsburg, USA (Abst )Google Scholar
  50. 50.
    Piper I, Spiegelberg A, Whittle I, Signorini D, Mascia L (1999) A comparative study of the Spiegelberg compliance device with a manual volume-injection method: a clinical evaluation in patients with hydrocephalus. Br J Neurosurg 13: 581–586PubMedCrossRefGoogle Scholar
  51. 51.
    Piper I, Contant C, Citerio G (2000) Brain Monitoring With Information Technology. The BRAIN IT group experience. Minerva Anestesiol 66 (suppl 1/5): 17–21Google Scholar
  52. 52.
    Piper IR, Yau Y, Contant C, et al (2000) Multi-centre assessment of the Spiegelberg compliance monitor: Preliminary results. Acta Neurochir Suppl 76: 491–494Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • G. Citerio
  • I. Piper

There are no affiliations available

Personalised recommendations