Since the introduction of continuous recording of intracranial pressure (ICP) in neurosurgical practice (Guillaume and Janny, 1951; Lundberg, 1960) this method has greatly contributed to clinical research in the field of intracranial hypertension. Numerous publications have enriched the literature on ICP and five International Symposia (1972, 1974, 1976, 1979 and 1982) on the subject have been held. The knowledge gained from these investigations has considerably benefited the management of patients suffering from raised ICP. However, in spite of the enthousiasm among those who practise ICP monitoring, the method has not yet gained universal acceptance as a routine procedure with regard to the various aspects of care of the individual patient: diagnosis, surveillance, treatment and prognosis. The question of the clinical value of ICP monitoring is, of course, closely related to the question as to what extent ICP truly reflects central nervous system function. In our view the answer to this question must be sought somewhere between the two extremes expressed in the statements of Stern (1963) "that ICP should be given a subsidiary role in the assessment of the fluid-mass dynamics in neurological disease" and of Langfitt (1969) "that uncontrolled, increased ICP is one of the most common causes of neurological death". This dilemma is clinically illustrated by the common experience that high levels of ICP may be sustained by normal subjects without evidence of neurological impairment (Evans et al., 1951), whereas patients with large space-occupying lesions may have clinical signs of brainstem distortion without significant elevation of ICP. Much of this controversy results from the two-fold meaning of increased ICP. On the one hand it may be regarded as a symptom indicating the presence of a space-occupying process, of whatever nature, which can no longer be compensated for. On the other hand intracranial hypertension may be a pathogenetic factor causing brain dysfunction per se. The latter aspect in particular is still controversial; for instance, it is not yet known for certain which level of ICP is so critical that it requires treatment. The interaction between ICP and brain function is apparently so complex that no simple deductions can be made from the level of ICP alone. It is therefore necessary to consider many other aspects of ICP that 'matter' (Jennett, 1976) such as: the cause and rate of development of intracranial hypertension, the presence of pressure waves, brain shift, and of pressure gradients, the cerebral perfusion pressure, and the craniospinal volume-pressure relationships

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G. van den Brink , M. de Vlieger (Marinus) , S.A. de Lange
Erasmus University Rotterdam , The Hague : Jongbloed
Erasmus MC: University Medical Center Rotterdam

Avezaat, C.J.J, & van Eijndhoven, J.H.M. (1984, February). Cerebrospinal fluid pulse pressure and craniospinal dynamics : a theoretical, clinical and experimental study. The Hague : Jongbloed. Retrieved from