Intracranial pulsatile pressure gradient: a hypothesis and the potential role of dual intracranial pressure monitoring
Year: 2026
Type: article
Abstract: Intracranial pressure (ICP) monitoring is widely used in neurosurgical practice and the two key ICP variables, mean pressure and pulse amplitude, provide important information about intracranial compliance and cerebrospinal fluid dynamics. Mean ICP is assumed to be uniformly distributed and monitoring at a single intracranial location is considered representative of global ICP, but whether pulse amplitude is spatially uniform within the intracranial cavity remains uncertain. This article proposes the hypothesis that ICP waves undergo spatial attenuation within the skull resulting in an intracranial pulsatile pressure gradient. The hypothesis is supported by physiological principles of wave propagation and by evidence demonstrating attenuation of pressure waves along the craniospinal axis, although intracranial attenuation has not yet been experimentally demonstrated. This manuscript proposes that this hypothesis could be investigated using synchronous ICP measurements at two intracranial sites separated by a defined distance. It also describes the concept of a dual-sensor intracranial catheter, incorporating deep and superficial pressure sensors, that could provide simultaneous measurements and quantify the hypothetical spatial attenuation. Demonstrating an intracranial pulsatile pressure gradient could provide new insights into intracranial hydrodynamics and the interpretation of ICP pulsatility, with potential implications for neurosurgical conditions including traumatic brain injury, normal pressure hydrocephalus, idiopathic intracranial hypertension, and Chiari malformation.
Source: Frontiers in Surgery
Author: Georgios Tsermoulas
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223188491