A Non-invasive Assessment of Intracranial Volume Reserve by Measuring Cerebrospinal Fluid Volume with the Aid of CT Imaging

  • Mariusz Glowacki
  • Karol Budohoski
  • Piotr Marszalek
  • Jerzy Walecki
  • Zbigniew Czernicki
Conference paper
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 106)



Monitoring changes in the intracranial volume (ICV) reserve and intracranial pressure (ICP) is one of the key issues in the treatment of intracranial pathologies. The aim of this study is to develop a method of monitoring the ICV reserve by analyzing CSF volume measured using CT in specific regions.

Materials and Methods

A total of 20 patients with cerebral injury were evaluated. Analysis was performed using imaging software. On selected scans (three at the basal cistern level and three at the pineal level), the following regions were analyzed: total cerebral surface (TC1, TC2) and bilateral ambient cistern (AC) only at the basal cistern level for cerebrospinal fluid (CSF) volume. Results were correlated with patients’ Glasgow Coma Scale (GCS) scores.


An increase of CSF volume was observed with an improvement in the GCS. From the examined regions, only AC volume showed a statistically significant linear correlation (p < 0.0005) with GCS. Mean AC: 0.021, 0.454, and 0.678 mL CSF/scan in severe (3–8 pts GCS), moderate (9–12 pts GCS), and mild (13–15 pts GCS) TBI groups, respectively.


Assessment of CSF volume changes in mL CSF/scan can be conducted using CT. Counting voxels corresponding to the CSF eliminates mistakes due to inaccurate region demarcation. The obtained results (AC volume) show a high correlation with patient state.


Intracranial pressure intracranial volume reserve traumatic brain injury non-invasive ICP monitoring voxel 


  1. 1.
    Børgesen SE, Albeck MJ, Gjerris F, Czosnyka M, Laniewski P (1992) Computerized infusion test compared to steady pressure constant infusion test in measurement of resistance to CSF outflow. Acta Neurochir (Wien) 119(1–4):12–16CrossRefGoogle Scholar
  2. 2.
    Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, Kalkman CJ (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med Oct 33(10):2207–2213CrossRefGoogle Scholar
  3. 3.
    Czernicki Z, Berdyga J, Stepińska G, Jurkiewicz J (1995) Evaluation of craniospinal system condition using standardized volume-pressure loadings. Acta Neurochir (Wien) 133(3–4):191–194CrossRefGoogle Scholar
  4. 4.
    Czernicki Z, Walecki J (1990) Evaluation of oedema spreading and intracranial volume reserve using CT image numerical analysis. Acta Neurochir Suppl (Wien) 51:407–408Google Scholar
  5. 5.
    Czernicki Z, Walecki J, Jurkiewicz J, Grochowski W, Tychmanowicz K (1992) Intracranial volume reserve determination using CT images, numerical analysis and lumbar infusion tests. An experimental study. Acta Neurochir (Wien) 115(1–2):43–46CrossRefGoogle Scholar
  6. 6.
    Czernicki Z, Głowacki M, Walecki J, Jurkiewicz J, Walasek N (2007) Optimalization of the neurosurgical care – a multicentre telemedical project. In: International Proceedings, reprinted from 13th European Congress of Neurosurgery, Glasgow, September, 2–7, 719–722Google Scholar
  7. 7.
    Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry Jun; 75(6):813–821Google Scholar
  8. 8.
    Fountas KN, Sitkauskas A, Feltes CH, Kapsalaki EZ, Dimopoulos VG, Kassam M, Grigorian AA, Robinson JS, Ragauskas A (2005) Is non-invasive monitoring of intracranial pressure waveform analysis possible? Preliminary results of a comparative study of non-invasive vs. invasive intracranial slow-wave waveform analysis monitoring in patients with brain injury. Med Sci Monit Feb; 11(2):CR58–CR63Google Scholar
  9. 9.
    Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J (2008) Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med Nov 34(11). [Epub 2008 May 29; 2062–7]Google Scholar
  10. 10.
    Głowacki M, Czernicki Z, Jurkiewicz J (2004) Teleconsulting in multidisciplinary approach to the trauma patient. In: Abstracts of the Proceedings of 9th Congress of the Euroacademia Multidisciplinaria Neurotraumatologica, Bucharest, Romania, 19–22 May; Acta Neurochir (2006) 148:IIGoogle Scholar
  11. 11.
    Głowacki M, Czernicki Z, Jurkiewicz J, Walasek N (2005) Teleradiology in neurosurgery, based on the experience of the Department of Neurosurgery, Polish Academy of Sciences. Pol J Radiol 70(4): 27–34Google Scholar
  12. 12.
    Głowacki M, Czernicki Z, Mierzejewski M, Jurkiewicz J (2003) Teleconsulting in the Management of Acute Neurotrauma. Euroacademia Multidipsciplinaria Neurotraumatologica 155:61–67Google Scholar
  13. 13.
    Głowacki M (2006) Teleradiology in clinical practice. Pol J Radiol 71(4):99–117Google Scholar
  14. 14.
    Kosteljanetz M (1987) Intracranial pressure: cerebrospinal fluid dynamics and pressure–volume relations. Acta Neurol Scand Suppl 111:1–23PubMedGoogle Scholar
  15. 15.
    Kroin JS, Nagalla SK, Buvanendran A, McCarthy RJ, Tuman KJ, Ivankovich AD (2002) The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model. Anesth Analg Aug; 95(2): 423–429Google Scholar
  16. 16.
    Louis PT, Goddard-Finegold J, Fishman MA, Griggs JR, Stein F, Laurent JP (1993) Barbiturates and hyperventilation during intracranial hypertension. Crit Care Med Aug; 21(8):1200–1206Google Scholar
  17. 17.
    Mauritz W, Steltzer H, Bauer P, Dolanski-Aghamanoukjan L, Metnitz P (2008) Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study. Intensive Care Med Jul; 34(7):1208–1215. Epub 2008 Mar 26Google Scholar
  18. 18.
    Narayan RR (1994) Intracranial pressure and CT. J Neurosurg Nov; 81(5):810–811Google Scholar
  19. 19.
    Ng SC, Poon WS, Chan MT (2005) Cerebral haemodynamic assessment in patients with thalamic haemorrhage: a pilot study with continuous compliance monitoring. Acta Neurochir Suppl 95:299–301PubMedCrossRefGoogle Scholar
  20. 20.
    Shafi S, Diaz-Arrastia R, Madden C, Gentilello L (2008) Intracranial pressure monitoring in brain-injured patients is associated with worsening of survival. J Trauma Feb; 64(2):335–340Google Scholar
  21. 21.
    Styrke J, Stålnacke BM, Sojka P, Björnstig U (2007) Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J Neurotrauma Sep; 24(9):1425–1436Google Scholar
  22. 22.
    Sullivan HG, Miller JD, Becker DP, Flora RE, Allen GA (1977) The physiological basis of intracranial pressure change with progressive epidural brain compression. An experimental evaluation in cats. J Neurosurg Oct; 47(4):532–550Google Scholar
  23. 23.
    Ueno T, Macias BR, Yost WT, Hargens AR (2005) Noninvasive assessment of intracranial pressure waveforms by using pulsed phase lock loop technology. Technical note. J Neurosurg Aug; 103(2):361–367Google Scholar
  24. 24.
    Zwetnow NN, Schrader H, Löfgren J (1986) Effects of continuously expanding intracranial lesions on vital physiological parameters. An experimental animal study. Acta Neurochir (Wien) 80(1–2):47–56CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2010

Authors and Affiliations

  • Mariusz Glowacki
    • 1
  • Karol Budohoski
    • 3
    • 4
  • Piotr Marszalek
    • 1
  • Jerzy Walecki
    • 2
  • Zbigniew Czernicki
    • 3
    • 4
  1. 1.Department of NeurosurgeryM. Mossakowski Medical Research Center, Polish Academy of SciencesWarsawPoland
  2. 2.Department of Radiology and Department of Experimental PharmacologyPolish Academy of Sciences Medical Research CenterWarsawPoland
  3. 3.Department of NeurosurgeryM. Mossakowski Medical Research Center, Polish Academy of SciencesWarsawPoland
  4. 4.Department of Neursourgery, Medical Research Center, Polish Academy of Sciences and Department of NeurosurgeryMedical University of WarsawWarsawPoland

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