Intracranial pressure management in severe intraventricular hemorrhage: A minireview

Table 2 Comparative analysis of intracranial pressure monitoring techniques in severe intraventricular hemorrhage

Technique	Accuracy	Advantages	Limitations	IVH-specific utility
EVD with ICP integration	Gold standard	Therapeutic drainage + monitoring	Infection risk (8%-15%), occlusion by clot	Enables thrombolytic administration, preferred for obstructive hydrocephalus
Parenchymal fiberoptic	± 2 mmHg	Low infection risk, compartment-specific data	Drift > 1 mmHg/day, no therapeutic function	Essential for large parenchymal extensions (> 15 mL)
ONSD ultrasound	Unstable, sensitivity 90%, specificity 60%-85%	Rapid bedside application	Overestimates ICP in acute hydrocephalus	Best for rapid triage when EVD unavailable
TCD pulsatility index	r = 0.68 with ICP	Autoregulation assessment	Operator-dependent, limited temporal windows	CPP titration during vasopressor use

IVH: Intraventricular hemorrhage; EVD: External ventricular drainage; ICP: Intracranial pressure; ONSD: Optic nerve sheath diameter; TCD: Transcranial Doppler; CPP: Cerebral perfusion pressure.