Intracranial pulsatile pressure gradient: a hypothesis and the potential role of dual intracranial pressure monitoring
- 1Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- 2Metabolism and Systems Science, School of Medical Sciences, University of Birmingham, Birmingham, United Kingdom
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.
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BibTeX
@article{tsermoulas2026intracranial,
title = {{Intracranial pulsatile pressure gradient: a hypothesis and the potential role of dual intracranial pressure monitoring}},
author = {Georgios Tsermoulas},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1965112},
url = {https://doi.org/10.3389/fsurg.2026.1965112},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Intracranial pulsatile pressure gradient: a hypothesis and the potential role of dual intracranial pressure monitoring
AU - Georgios Tsermoulas
PY - 2026
DA - 2026/10/22
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1965112
UR - https://doi.org/10.3389/fsurg.2026.1965112
AB - 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.
SN - 2296-875X
ER -