PDF(Pubmed)
Abstract：
Intracranial compliance (ICC) holds significant potential in neuromonitoring, serving as a diagnostic tool and contributing to the evaluation of treatment outcomes. Despite its comprehensive concept, which allows consideration of changes in both volume and intracranial pressure (ICP), ICC monitoring has not yet established itself as a standard component of medical care, unlike ICP monitoring. This review highlighted that the first challenge is the assessment of ICC values, because of the invasive nature of direct measurement, the time-consuming aspect of non-invasive calculation through computer simulations, and the inability to quantify ICC values in estimation methods. Addressing these challenges is crucial, and the development of a rapid, non-invasive computer simulation method could alleviate obstacles in quantifying ICC. Additionally, this review indicated the second challenge in the clinical application of ICC, which involves the dynamic and time-dependent nature of ICC. This was considered by introducing the concept of time elapsed (TE) in measuring the changes in volume or ICP in the ICC equation (volume change/ICP change). The choice of TE, whether short or long, directly influences the ICC values that must be considered in the clinical application of the ICC. Compensatory responses of the brain exhibit non-monotonic and variable changes in long TE assessments for certain disorders, contrasting with the mono-exponential pattern observed in short TE assessments. Furthermore, the recovery behavior of the brain undergoes changes during the treatment process of various brain disorders when exposed to short and long TE conditions. The review also highlighted differences in ICC values across brain disorders with various strain rates and loading durations on the brain, further emphasizing the dynamic nature of ICC for clinical application. The insight provided in this review may prove valuable to professionals in neurocritical care, neurology, and neurosurgery for standardizing ICC monitoring in practical application related to the diagnosis and evaluation of treatment outcomes in brain disorders.
摘要：
颅内顺应性（ICC）在神经监测中具有重要的潜力，作为诊断工具，有助于评估治疗结果。尽管它的概念全面，这允许考虑容量和颅内压（ICP）的变化，ICC监测尚未确立为医疗保健的标准组成部分，与ICP监测不同。这篇评论强调，第一个挑战是对国际商会价值观的评估，由于直接测量的侵入性，通过计算机模拟进行非侵入性计算的耗时方面，以及无法在估计方法中量化ICC值。应对这些挑战至关重要，和快速发展，非侵入性计算机模拟方法可以缓解ICC量化的障碍。此外,这篇综述指出了ICC临床应用的第二个挑战，这涉及到ICC的动态和时间依赖性。这是通过在测量ICC方程中的体积或ICP的变化(体积变化/ICP变化)时引入经过时间(TE)的概念来考虑的。TE的选择,无论是短还是长，直接影响ICC的临床应用中必须考虑的ICC值。在某些疾病的长期TE评估中，大脑的代偿性反应表现出非单调和可变的变化。与在短期TE评估中观察到的单指数模式形成对比。此外，在各种脑部疾病的治疗过程中，当暴露于短期和长期TE条件时，大脑的恢复行为会发生变化。该评论还强调了不同脑部疾病的ICC值的差异，这些脑部疾病具有不同的应变率和负载持续时间，进一步强调ICC临床应用的动态性。这篇综述提供的见解可能对神经重症监护专业人员很有价值，神经学,和神经外科在与脑部疾病的诊断和治疗结果评估相关的实际应用中标准化ICC监测。
