Neurosurgical Procedures in Patients with Cirrhosis and Acute Liver Failure: Indications, Safety, and Feasibility of Intracranial Pressure Monitor Devices

  • Jeffrey P. Mullin
  • Connor Wathen
  • Alvin Chan
  • Edward C. Benzel


Hepatic encephalopathy (HE) is highly associated with elevated intracranial pressure (ICP), as well as hemorrhagic complications associated with liver failure related coagulopathy. To date, invasively ICP monitoring in affected patients has been somewhat controversial because of potential complications, specifically the risk of hemorrhage associated with implantation of the monitoring device, and the paucity of evidence showing the benefit of ICP monitoring. The true risk of hemorrhage remains unknown, as the literature has shown that the risk may be high or low, depending on the study. Therefore, the risk is likely contingent on the protocol and management strategies. Despite this controversy, invasive ICP monitoring remains the most accurate means of tracking a patient’s ICP and could potentially provide benefit in some patients, though the profile of such patients is yet to be elucidated.


Hepatic encephalopathy Intracranial hypertension Intracranial monitoring Cirrhosis of the liver Acute liver failure 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Jeffrey P. Mullin
    • 1
  • Connor Wathen
    • 2
  • Alvin Chan
    • 3
  • Edward C. Benzel
    • 1
  1. 1.Department of NeurosurgeryCleveland Clinic, Neurological InstituteClevelandUSA
  2. 2.Cleveland Clinic Lerner College of MedicineClevelandUSA
  3. 3.Medical College of WisconsinMilwaukeeUSA

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