From disease to noninvasive intracranial monitoring

Folchini, Caroline Mensor; Karuta, Simone Carreiro Vieira; Ricieri, Marinei Campos; Motta, Fábio Araújo; Manços, Guilherme de Rosso; Frigieri, Gustavo; Maeda, Adriano Keirijo

doi:10.1590/0004-282X-ANP-2021-0298

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Historical Note • Arq. Neuro-Psiquiatr. 80 (5) • May 2022 • https://doi.org/10.1590/0004-282X-ANP-2021-0298 copy

From disease to noninvasive intracranial monitoring

Da doença ao monitoramento intracraniano não invasivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Professor Sérgio Mascarenhas was a Brazilian researcher with a vast legacy. His work paved the way for new research possibilities by consolidating the use of innovation and transdisciplinary science. In Medicine, he proposed changes to what had previously been well-accepted concepts, and his contributions have influenced medical practices. Although many authors consider intracranial pressure (ICP) as an unrivaled variable for monitoring and diagnosis of many diseases, its clinical applicability is still the subject of debate in the literature because of the difficulty in standardizing protocols. Mascarenhas's research and the creation of a device for noninvasive monitoring of intracranial compliance are discussed and are shown to have led to the creation of Brain4care, a start-up, and a new perspective on the debate on ICP monitoring.

Keywords:
Hydrocephalus, Normal Pressure; Parkinson Disease; Monitoring

Technique	Classification	Strengths and limitations
Ventricular catheter	Invasive	Measures global ICP. 2. Can be recalibrated. 3. Can drain cerebral fluid. 4. Increased risk of infection.
Intraparenchymal catheter	Invasive	1. Higher cost. 2. Can be calibrated. 3. Cerebral fluid cannot be drained. 4. Risk of infection.
Implantable ICP sensors	Invasive	Risk of bleeding and infection.
Telemetry sensors and miniature sensors	Invasive	1. Biocompatible electronics, biocompatible energy sources, and efficient telemetry. 2. Bleeding and risk of infection.
Biodegradable pressure sensors	Invasive	1. Risk of infection.
Lumbar puncture	Invasive	1. If CSF pathways are occluded, ICP will not be measured correctly. 2. Risk of infection.
Monitoring of epidural ICP	Invasive	Risk of bleeding is reduced. 2. Risk of infection.
Transcranial Doppler	Noninvasive	1. Highly user-dependent. 2. Small changes in probe direction can significantly affect the Doppler signal. 3. Affected by other changes in physiology such as medication-related changes, autoregulation, and hyperemia.
Optical methods	Noninvasive	Depends on a patent cochlear aqueduct, which serves as a mechanical filter for transmitting ICP-derived signals.
Image-based methods	Noninvasive	1. Provides only short term assessments. 2. Repetitive measurements not possible. 3. Expensive and not available in many settings.
Acoustic methods	Noninvasive	1. There are no validated acoustic methods for measuring ICP noninvasively.
Optic nerve sheath diameter	Noninvasive	Manipulator-dependent. 2. Ability to separate high and low ICP makes it primarily a screening tool and less valuable at the bedside.
Brain4care	Noninvasive	Manipulator-dependent. 2. Monitoring in presurgical patients.

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[1] Correspondence: Simone Carreiro Vieira Karuta; Email: sizetecv@yahoo.com.br.