Abstract
Despite the envisioned breakthrough prophesied for
the end of the past century in healing brain injured patients,
both clinicians and basic scientists are still struggling
with this burden. In the past decades, intensive
research has brought forward a plethora of different
targets which – in part – have already been integrated
in clinical routine directed at detailed monitoring, therapeutic
interventions, and prevention of secondary deterioration.
While intracellular targets remain obscure
alterations on a larger scale as e.g., measured intracranial
pressure (ICP), calculated cerebral perfusion pressure
(CPP), and various imaging techniques are fundamental
components of our present clinical
understanding. At bedside, comprehension of pathophysiological
loops and circuits of a given value (e.g.,
ICP) depends on individual knowledge, interpretation,
and availability of additional diagnostic steps. As stated
in the guidelines brought forward by the American Association
of Neurological Surgeons and evaluated in
various reports by the Cochrane Library we are still lacking
prospective, randomized trials for the majority of
the proposed diagnostic and therapeutic interventions.
In this context, a recent meta-analysis even questioned
the importance of ICP monitoring as we are lacking data
from randomized controlled trials clarifying the role
of ICP monitoring. The present review is to give an overview
of various diagnostic and therapeutic possibilities
based on reports published in the past 5 years to
strengthen current approaches and nourish future
well-designed investigations how to avoid and treat intracranial
hypertension.
Stover, J F