Overview
Introduction
ICP monitoring provides continuous measurement of pressure within the cranial vault, enabling early detection of dangerous elevations and guiding therapy.
ICP monitoring provides continuous measurement of pressure within the cranial vault, enabling early detection of dangerous elevations and guiding therapy. Normal ICP is 5-15 mmHg; sustained pressures above 20 mmHg require intervention. The external ventricular drain (EVD/ventriculostomy) is the gold standard — it measures ICP AND allows therapeutic CSF drainage. A catheter is placed into the lateral ventricle (usually right, non-dominant hemisphere) and connected to a fluid-coupled transducer and drainage system. The intraparenchymal monitor (e.g., Codman or Camino) is a fiber-optic or strain-gauge sensor placed directly into brain tissue — it cannot drain CSF but has lower infection risk and does not require releveling. ICP waveforms provide critical information about intracranial compliance: P1 (percussion wave) originates from arterial pulsation transmitted through choroid plexus; P2 (tidal wave) reflects brain tissue compliance; P3 (dicrotic wave) follows the dicrotic notch. In normal compliance, P1 > P2 > P3 (descending staircase). When P2 exceeds P1 (ascending morphology), intracranial compliance is DECREASED — the brain cannot accommodate further volume increases and herniation risk is elevated. Lundberg A waves (plateau waves: sustained ICP elevations to 50-100...
