Non-invasive intracranial pressure monitoring concept

Decoding Brain Pressure: Can We Predict ICP Non-Invasively?

Samir D’Costa in Health & Wellness December 2025 • 5 min read.

"New research explores the potential of using aortic pressure waveforms to estimate intracranial pressure, offering hope for safer, more accessible brain monitoring."

Monitoring intracranial pressure (ICP) is essential in neurosurgical and intensive care settings to manage patients with severe brain injuries or diseases. Traditional ICP monitoring involves invasive procedures, such as inserting a pressure sensor or drain into the brain, which carries risks of hemorrhage and infection and requires specialized expertise. Consequently, ICP monitoring is typically reserved for patients with severe conditions where the benefits outweigh the risks.

The potential benefits of a non-invasive ICP monitoring method are vast, leading to the exploration of various techniques. These include imaging-based methods, optic nerve sheath diameter evaluation, tympanic membrane displacement, and transcranial Doppler ultrasonography. Another approach involves estimating mean ICP or other ICP parameters from radial artery blood pressure measurements, sometimes combined with additional measurements. This is appealing because radial artery blood pressure is easily accessible and can be monitored continuously.

This article discusses research focusing on estimating the pulsatile component of ICP derived from cardiac activity. The pulsatile ICP is primarily influenced by beat-to-beat arterial blood pressure pulsations transmitted into the intracranial compartment. Researchers propose that the central aortic blood pressure waveform is a more accurate source for non-invasive ICP estimation compared to the radial artery waveform.

How Can Aortic Pressure Waveforms Help Estimate ICP?

Non-invasive intracranial pressure monitoring concept

The study, highlighted in the World Neurosurgery News article, explores the possibility of using central aortic blood pressure waveforms to estimate ICP. The rationale behind this approach stems from the understanding that pulsatile ICP is driven by cardiac activity and the transmission of arterial blood pressure pulsations into the intracranial space. Researchers suggest that the central aortic blood pressure waveform is more closely related to the ICP waveform than the radial artery waveform.

The research team focused on the mean wave amplitude of the ICP waveform (MWAICP), a parameter believed to reflect the physical characteristics of the intracranial space. They aimed to estimate MWAICP non-invasively using estimates of central aortic blood pressure waveforms derived from radial artery blood pressure measurements using the SphygmoCor system.

Patient-Specific Transfer Functions: To evaluate the potential of central aortic estimates, patient-specific transfer functions were calculated using spectral analysis, with central aortic signals as input and invasively obtained ICP signals as output.
Study Population: The study included 29 patients with idiopathic normal pressure hydrocephalus and ICP levels within the normal range.
Methodology: Researchers calculated patient-specific transfer functions and applied them to central aortic estimates to obtain pulsatile non-invasive ICP estimates. They then used the transfer function that yielded the best spectral correlation between ICP estimates and ICP signals across the entire cohort.

The study found that this method provided reasonably accurate MWAICP estimates for about one-third of the individuals. However, the results also indicated that the assumption of a linear relationship between central aortic blood pressure and ICP might be too simplistic, suggesting that a more complex model is needed for more accurate results. The researchers concluded that while the approach shows promise, it is not yet reliable for clinical patient management but warrants further investigation with a broader range of ICP values.

Future Directions: Improving Non-Invasive ICP Estimation

The study by Evensen et al. represents a step toward non-invasive ICP monitoring, offering a potential alternative to the risks and limitations of current invasive methods. The ability to accurately estimate ICP non-invasively could revolutionize the management of various neurological conditions, allowing for earlier detection of problems and more personalized treatment strategies.

Further research is needed to refine the methodology and address the limitations identified in the study. This includes exploring more complex models that capture the non-linear relationship between aortic blood pressure and ICP, as well as validating the approach in a larger and more diverse patient population with a wider range of ICP values.

Ultimately, the development of a reliable non-invasive ICP monitoring technique could significantly improve patient outcomes, reduce healthcare costs, and expand access to neurological care. This research highlights the ongoing efforts to unlock the secrets of the brain and develop innovative solutions for improving brain health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.wneu.2018.10.079, Alternate LINK

Title: Noninvasive Estimation Of Intracranial Pressure Waveform From Central Aortic Pressure Waveform

Subject: Neurology (clinical)

Journal: World Neurosurgery

Publisher: Elsevier BV

Authors: Karen Brastad Evensen, Per Kristian Eide

Published: 2019-01-01

Everything You Need To Know

What is the significance of monitoring Intracranial Pressure (ICP)?

Intracranial pressure (ICP) monitoring is a critical process, especially in neurosurgical and intensive care settings. Its importance lies in the management of patients with severe brain injuries or diseases. Traditional methods of monitoring ICP are invasive, involving procedures like inserting a pressure sensor or drain into the brain. These methods carry risks of hemorrhage and infection and require specialized expertise. Consequently, ICP monitoring is typically reserved for patients with severe conditions where the benefits outweigh the risks.

How do aortic pressure waveforms relate to ICP monitoring?

The study focuses on using central aortic blood pressure waveforms to estimate Intracranial Pressure (ICP). The rationale is that the pulsatile component of ICP is primarily influenced by arterial blood pressure pulsations originating from cardiac activity. Researchers propose that the central aortic blood pressure waveform is a more accurate source for non-invasive ICP estimation compared to the radial artery waveform because it is more closely related to the ICP waveform. This approach could potentially offer a safer and more accessible method for monitoring ICP.

What methodology did the study employ to estimate ICP?

The study uses several key elements. It involves calculating patient-specific transfer functions using spectral analysis, with central aortic signals as input and invasively obtained ICP signals as output. The study population consisted of 29 patients with idiopathic normal pressure hydrocephalus and ICP levels within the normal range. Researchers then applied these transfer functions to central aortic estimates to obtain pulsatile non-invasive ICP estimates. The study found that this method provided reasonably accurate MWAICP estimates for about one-third of the individuals. However, the results also indicated that the assumption of a linear relationship between central aortic blood pressure and ICP might be too simplistic, suggesting that a more complex model is needed for more accurate results. Researchers concluded that while the approach shows promise, it is not yet reliable for clinical patient management but warrants further investigation with a broader range of ICP values.

Why did the researchers focus on Mean wave amplitude of the ICP waveform (MWAICP)?

Mean wave amplitude of the ICP waveform (MWAICP) is a parameter that reflects the physical characteristics of the intracranial space. The researchers aimed to estimate MWAICP non-invasively using central aortic blood pressure waveforms derived from radial artery blood pressure measurements. They used the SphygmoCor system for this. The study focused on estimating MWAICP because it provides insights into the dynamics within the intracranial space and its potential to be used to evaluate non-invasive ICP.

What are the limitations and future directions of non-invasive ICP estimation based on this research?

While the initial results are promising, the study acknowledges limitations and indicates the need for further investigation. The study found that the assumption of a linear relationship between central aortic blood pressure and ICP might be too simplistic, indicating that a more complex model is needed. The researchers concluded that while the approach shows promise, it is not yet reliable for clinical patient management but warrants further investigation with a broader range of ICP values. The goal is to improve the accuracy and reliability of non-invasive ICP estimation, with the ultimate aim of clinical applicability. This is due to the potential for earlier detection of problems and more personalized treatment strategies.