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Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2023

15-04-2023 | Central Nervous System Trauma | Original Article

Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?

Authors: Matheus Ballestero, Celeste Dias, Inês Catarina Neves Gomes, Luca Soares Grisi, Rodrigo Augusto Monteiro Cardoso, Edson Luis Zucoloto Júnior, Ricardo Santos de Oliveira

Published in: Acta Neurochirurgica | Issue 6/2023

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Abstract

Purpose

Individuals with TBI are at risk of intracranial hypertension (ICH), and monitoring of intracranial pressure (ICP) is usually indicated. However, despite many new noninvasive devices, none is sufficiently accurate and effective for application in clinical practice, particularly in the management of TBIs. This study aimed to compare the noninvasive Brain4Care system (nICP) with invasive ICP (iICP) curve parameters in their ability to predict ICH and functional prognosis in severe TBI.

Methods

Observational, descriptive-analytical, and prospective study of 22 patients between 2018 and 2021, simultaneously monitored with nICP and iICP. The independent variables evaluated were the presence of ICH and functional prognoses. The dependent variables were the P2/P1 pressure ratio metrics, time to peak (TTP), and TTP × P2/P1.

Results

We found a good nonlinear correlation between iICP and nICP waveforms, despite a moderate Pearson’s linear correlation. The noninvasive parameters of P2/P1, P2/P1 × TTP, and TTP were not associated with outcomes or ICH. The nICP P2/P1 ratio showed sensitivity/specificity/accuracy (%) of 100/0/56.3, respectively for 1-month outcomes and 77.8/22.2/50 for 6-month outcomes. The nICP TTP ratio had values of 100/0/56.3 for 1-month and 99.9/42.9/72.2 for 6-month outcomes. The nICP P2/P1 × TTP values were 100/0/56.3 for 1-month outcomes and 81.8/28.6/61.1 for 6-month outcomes.

Conclusion

Brain4Care’s noninvasive method showed low specificity and accuracy and cannot be used as the sole means of monitoring ICP in patients with severe TBI. Future studies with a larger sample of patients with P2 > P1 and new nICP curve parameters are warranted.
Appendix
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Literature
1.
Ayres C, Vellosa JCR (2022) Noninvasive monitoring of intracranial pressure after cardiac surgery: case report. Research, Society and Development 11(6):e56011629492–e56011629492CrossRef
2.
Ballestero MFM, Frigieri G, Cabella BCT, de Oliveira SM, de Oliveira RS (2017) Prediction of intracranial hypertension through noninvasive intracranial pressure waveform analysis in pediatric hydrocephalus. Childs Nerv Syst 33(9):1517–1524CrossRefPubMed
3.
Beaumont A (2017) Physiology of the cerebrospinal fluid and intracranial pressure. In: Winn HR, Youmans JR (eds) Youmans and Winn neurological surgery, 7th edn. Elsevier/Saunders, Philadelphia, pp 417–423
4.
Bekar A, Doğan S, Abaş F, Caner B, Korfali G, Kocaeli H, Yilmazlar S, Korfali E (2009) Risk factors and complications of intracranial pressure monitoring with a fiberoptic device. J Clin Neurosci 16(2):236–240CrossRefPubMed
5.
Bollela VR, Frigieri G, Vilar FC et al (2017) Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis. Braz J Med Biol Res 50(9):e6392CrossRefPubMedPubMedCentral
6.
7.
Brasil S, Frigieri G, Taccone FS, Robba C, Solla DJF, de Carvalho Nogueira R, Yoshikawa MH, Teixeira MJ, Malbouisson LMS, Paiva WS (2022) Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients. J Clin Monit Comput 1–8
8.
9.
10.
11.
Cabella B, Vilela GHF, Mascarenhas S et al (2016) Validation of a new noninvasive Intracranial pressure monitoring method by direct comparison with an invasive technique. Acta Neurochir Suppl 122:93–96CrossRefPubMed
12.
Carney N, Totten AM, O’Reilly C et al (2017) Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80(1):6–15CrossRefPubMed
13.
Carteri RBK, da Silva RA (2021) Traumatic brain injury hospital incidence in Brazil: an analysis of the past 10 years. Rev Bras Ter Intensiva 33(2):282–289CrossRefPubMedPubMedCentral
14.
Cherain LGG, de Sena Barbosa MG, de Souza RLV, de Souza Paula R, Campos GR, Silva I, Peixoto E, Rabelo NN (2021) Use of non-invasive sensor to assess intracranial compliance in the management of migraine patients: case report. Mapping Intimacies
15.
16.
Contant CF, Robertson CS, Crouch J, Gopinath SP, Narayan RK, Grossman RG (1995) Intracranial pressure waveform indices in transient and refractory intracranial hypertension. J Neurosci Methods 57(1):15–25CrossRefPubMed
17.
Czosnyka M, Guazzo E, Whitehouse M, Smielewski P, Czosnyka Z, Kirkpatrick P, Piechnik S, Pickard JD (1996) Significance of intracranial pressure waveform analysis after head injury. Acta Neurochir (Wien) 138(5):531–41; discussion 541
18.
Czosnyka M, Smielewski P, Timofeev I, Lavinio A, Guazzo E, Hutchinson P, Pickard JD (2007) Intracranial pressure: more than a number. Neurosurg Focus 22(5):E10CrossRefPubMed
19.
da Silveira D, Rabelo NN, de Sena Barbosa MG, Frigeri G, Vellosa JCR (2021) Intracranial pressure and laboratory parameters in high- and low-risk pregnant women. Surg Neurol Int 12:250PubMedPubMedCentral
20.
21.
22.
Dias C, Maia I, Cerejo A, Varsos G, Smielewski P, Paiva J-A, Czosnyka M (2014) Pressures, flow, and brain oxygenation during plateau waves of intracranial pressure. Neurocrit Care 21(1):124–132CrossRefPubMed
23.
Di Ieva A, Schmitz EM, Cusimano MD (2013) Analysis of intracranial pressure: past, present, and future. Neuroscientist 19(6):592–603CrossRefPubMed
24.
Drewnowsk B, Acras RN, Rickli C, Koch MS, Bueno BF, Novak RS, Vellosa JCR (2021) Non-invasive monitoring of intracranial pressure during midazolam-induced moderate sedation for upper gastrointestinal endoscopy. Brazilian J Develop 7(5):44822–44830
25.
26.
Fernandes MV, Rosso Melo M, Mowry FE, Lucera GM, Lauar MR, Frigieri G, Biancardi VC, Menani JV, Colombari DSA, Colombari E (2021) Intracranial pressure during the development of renovascular hypertension. Hypertension 77(4):1311–1322CrossRefPubMed
27.
Frigieri G, Andrade RAP, Dias C, Spavieri DL, Brunelli R, Cardim DA, Wang CC, Verzola RMM, Mascarenhas S (2018) Analysis of a non-invasive intracranial pressure monitoring method in patients with traumatic brain injury. Acta Neurochir Suppl 126:107–110CrossRefPubMed
28.
Frigieri G, Andrade RAP, Wang CC, Spavieri D, Lopes L, Brunelli R, Cardim DA, Verzola RMM, Mascarenhas S (2018) Analysis of a minimally invasive intracranial pressure signals during infusion at the subarachnoid spinal space of pigs. Acta Neurochir Suppl 126:75–77CrossRefPubMed
29.
Frigieri G, Robba C, Machado FS, Gomes JA, Brasil S (2023) Application of non-invasive ICP waveform analysis in acute brain injury: Intracranial Compliance Scale. ICMx 11(1):5CrossRefPubMedPubMedCentral
30.
Gega A, Utsumi S, Iida Y, Iida N, Tsuncda S (1980) Analysis of the wave pattern of CSF pulse wave. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Brock M (eds) Intracranial Pressure IV. Springer, Berlin Heidelberg, Berlin, Heidelberg, pp 188–190CrossRef
31.
Gomes I, Shibaki J, Padua B, Silva F, Gonçalves T, Spavieri-Junior DL, Frigieri G, Mascarenhas S, Dias C (2021) Comparison of waveforms between noninvasive and invasive monitoring of intracranial pressure. Acta Neurochir Suppl 131:135–140CrossRefPubMed
32.
Hu X, Glenn T, Scalzo F, Bergsneider M, Sarkiss C, Martin N, Vespa P (2010) Intracranial pressure pulse morphological features improved detection of decreased cerebral blood flow. Physiol Meas 31(5):679–695CrossRefPubMedPubMedCentral
33.
Junior AEA, Carbinatto FM, Tomaz CSR, Bagnato VS (2022) Photosonic treatment and fibromyalgia: the effect on brain compliance-case report. J Nov Physiother 12(510):2
34.
35.
Koch MS, Drewnowski B, Balzer ER, Baroni G, Schuinski AFM, Vellosa JCR (2022) Alteração da complacência intracraniana em paciente com doença renal crônica e diabetes mellitus T1: um relato de caso. Res, Soc Develop 11(8):e26811831153–e26811831153CrossRef
36.
Kristiansson H, Nissborg E, Bartek J, Andresen M, Reinstrup P, Romner B (2013) Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol 25(4):372–385CrossRefPubMed
37.
Lazaridis C, DeSantis SM, Smielewski P, Menon DK, Hutchinson P, Pickard JD, Czosnyka M (2014) Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg 120(4):893–900CrossRefPubMed
38.
Miller JD, Peeler DF, Pattisapu J, Parent AD (1987) Supratentorial pressures Part II.: Intracerebral pulse waves. Neurol Res 9(3):198–201CrossRefPubMed
39.
40.
Nagai Ocamoto G, Spavieri Junior DL, Matos Ribeiro JA, FrigieriVilela GH, Catai AM, Russo TL (2021) Noninvasive intracranial pressure monitoring in chronic stroke patients with sedentary behavior: a pilot study. Acta Neurochir Suppl 131:55–58CrossRefPubMed
41.
Rickli C, Cosmoski LD, Dos Santos FA, Frigieri GH, Rabelo NN, Schuinski AM, Mascarenhas S, Vellosa JCR (2021) Use of non-invasive intracranial pressure pulse waveform to monitor patients with end-stage renal disease (ESRD). PLoS ONE 16(7):e0240570CrossRefPubMedPubMedCentral
42.
Rickli C, Koch MS, Bueno BF, Vellosa JCR (2021) Effect of hemodialysis on cerebral compliance assessed in a non-invasive way: case report. Brazilian Journal of Development 7(1):10169–10177CrossRef
43.
44.
Rojas SSO, Ordinola AAM, Veiga VC, de Souza JM (2021) The use of a noninvasive intracranial pressure monitoring method in the intensive care unit to improve neuroprotection in postoperative cardiac surgery patients after extracorporeal circulation. Rev Bras Ter Intensiva 33(3):469–476CrossRefPubMedPubMedCentral
45.
Saba GT, Quintão VC, Zeferino SP, Simões CM, Coelho RF, Fazoli A, Nahas W, Vilela GHF, Carmona MJC (2021) Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report. Braz J Anesthesiol 71(6):656–659PubMedPubMedCentral
46.
Tenenbaum JB, de Silva V, Langford JC (2000) A global geometric framework for nonlinear dimensionality reduction. Science 290(5500):2319–2323CrossRefPubMed
47.
Wu J, He W, Chen W-M, Zhu L (2013) Research on simulation and experiment of noninvasive intracranial pressure monitoring based on acoustoelasticity effects. Med Devices (Auckl) 6:123–131PubMed
48.
Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, Webster JG (2017) Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas 38(8):R143–R182CrossRefPubMed
Metadata
Title
Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis?
Authors
Matheus Ballestero
Celeste Dias
Inês Catarina Neves Gomes
Luca Soares Grisi
Rodrigo Augusto Monteiro Cardoso
Edson Luis Zucoloto Júnior
Ricardo Santos de Oliveira
Publication date
15-04-2023
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-023-05580-z

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