INCREASED INTRACRANIAL PRESSURE AND ITS ROLE IN NEUROSURGICAL DISEASES

Elevation of intracranial pressure (ICP) is a central pathophysiological problem in neurosurgery, occurring in diverse conditions such as traumatic brain injury, intracranial hemorrhage, neoplasms, hydrocephalus, cerebral venous sinus thrombosis, and severe infections. Normally, resting ICP in adults ranges approximately 7–15 mmHg; sustained or rapidly rising ICP can reduce cerebral perfusion pressure, produce brain herniation, and result in permanent neurological deficits or death. Early recognition and targeted management of ICP are therefore critical components of modern neurocritical care, combining bedside monitoring, neuroimaging, and stepwise therapeutic interventions to prevent secondary brain injury.
Recent advances in continuous invasive ICP monitoring, including improved intraparenchymal sensors and external ventricular drainage systems with integrated pressure transducers, have increased the precision of bedside measurements and enabled real-time therapeutic titration. Parallel development of validated noninvasive estimation techniques—such as transcranial Doppler-derived indices, optic nerve sheath diameter ultrasound, and validated machine-learning models using multimodal physiological data—offers expanding options where invasive monitoring is unavailable or contraindicated. Current practice integrates multimodal monitoring (ICP, brain tissue oxygenation, continuous EEG, and cerebral microdialysis) to personalize treatment, optimize cerebral perfusion, and guide timing of surgical interventions.
Therapeutic strategies have evolved toward protocolized, tiered approaches: initial measures (head elevation, sedation, normothermia, CSF drainage), escalation with osmotherapy and hyperosmolar therapy, and definitive surgical options including decompressive craniectomy or lesion evacuation when indicated. Emerging evidence supports targeted individualized thresholds for intervention, informed by multimodal monitoring and patient-specific factors such as age, comorbidities, and injury phenotype. Ongoing research into neuroprotective pharmacotherapies, refined osmotherapy regimens, and device innovations aims to further reduce morbidity and mortality associated with intracranial hypertension.