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The Scientific World Journal
Volume 2014, Article ID 795762, 6 pages
Review Article

Brain Monitoring: Do We Need a Hole? An Update on Invasive and Noninvasive Brain Monitoring Modalities

1Department of Neurosurgery, The Walton Centre, Liverpool L9 7AL, UK
2Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, P.O. Box 167, Cambridge CB2 0QQ, UK

Received 21 August 2013; Accepted 7 October 2013; Published 23 January 2014

Academic Editors: W. W. Butt and P. Taccone

Copyright © 2014 D. G. Barone and M. Czosnyka. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The ability to measure reliably the changes in the physical and biochemical environment after a brain injury is of great value in the prevention, treatment, and understanding of the secondary injuries. Three categories of multimodal brain monitoring exist: direct signals which are monitored invasively; variables which may be monitored noninvasively; and variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software. Intracranial pressure (ICP) monitoring, either as stand-alone value or study of a dynamic trend, has become an important diagnostic tool in the diagnosis and management of multiple neurological conditions. Attempts have been made to measure ICP non-invasively, but this is not a clinical reality yet. There is contrasting evidence that monitoring of ICP is associated with better outcome, and further RCTs based on management protocol are warranted. Computer bedside calculation of “secondary parameters” has shown to be potentially helpful, particularly in helping to optimize “CPP-guided therapy.” In this paper we describe the most popular invasive and non invasive monitoring modalities, with great attention to their clinical interpretation based on the current published evidence.