Pressure monitoring shows hope for head injury patients, says US study
A new technique could allow physicians to assess brain pressure in patients with milder head injuries, according to a report in a respected US medical journal.
The 11 April issue of Science Translational Medicine describes how researchers at the Massachusetts Institute of Technology (MIT) based their novel approach on a computer model of bloodflow through the brain.
Intracranial pressure (ICP), or pressure in the brain, is normally gauged by drilling into the skull and inserting a catheter into brain tissue or a fluid-filled cavity within the brain: a method which, due to its difficulty and the risk of serious infection, is performed only on patients with the most grievous head injuries.
However, the MIT researchers were able to calculate ICP by measuring arterial blood pressure and taking an ultrasound measurement of the velocity of blood flow through the brain, both of which procedures are safer than the highly-invasive drill.
By way of this approach, physicians can constantly monitor changes in brain pressure while being warned of problems that might slowly build.
Since the pressure of blood entering the brain cannot be measured directly, the MIT team used radial arterial pressure as a proxy measurement, obtained by inserting a catheter at the wrist before using their bloodflow model to compensate for the location difference.
Because a finger cuff (similar to a blood-pressure arm cuff) can be used to measure peripheral arterial pressure continuously and non-invasively, the team is now seeing if data obtained in this way is accurate enough to be used in their model.
The researchers confirmed their technique's accuracy by using data obtained some years ago from patients with traumatic brain injury, which proved to be among the few data sets which covered all requisite measurements and proper time stamps.
Tests showed that the MIT results were slightly less accurate than those obtained from the best invasive procedures. However, they proved to be similar to other invasive procedures still in clinical use, as well as to some practised techniques that are less invasive.
James Holsapple, chief of neurosurgery at the Boston Medical Center, said finding a non-invasive method of measuring ICP is "the Holy Grail" of clinical neurosurgery. "It would be a big step if we could get our hands on something reliable."
Dr Holsapple added that the new MIT approach is promising and that the next significant step will be to incorporate the technology into a system that hospital staff find easy to use and which could record data over longer periods of time.
The study's co-author, Prof George Verghese, acknowledged that the new technique still required validation. "To convince people that this works, you need to build up more data than we currently have," he said.
"Our hope is that once it's been validated on additional sorts of patients, where you're able to show that you can match what the invasive measurement is, people will have confidence in starting to apply it to patients who are currently not getting monitored. That's where we see the big potential."
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