With the advent of newer devices for measuring intracranial pressure (ICP) and cerebral metabolism, more alternatives continue to rise aiming to control ICP. This manuscript presents a proposed analysis of different ICP monitoring devices in order to make appropriate selection of them in our clinical setting including general and pediatric applications. A systematic review of the literature was made analyzing the technical advances in ICP monitoring. The recent in vitro and in vivo tests as well as mathematical/computer models were reviewed. Practical applications of principles were discussed and compared based on the mode of pressure transformation. A ventricular catheter connected to an external strain gauge transducer or catheter tip pressure transducer device is considered to be the most accurate method of monitoring ICP and enables therapeutic CSF drainage. The significant infections or hemorrhage associated with ICP devices causing patients morbidity are clinically rare and should not deter the decision to monitor ICP. Parenchymal catheter tip pressure transducer devices are advantageous when ventricular ICP cannot be obtained or if there is an obstruction in the fluid couple, though they have the potential for significant measurement differences and drift due to the inability to recalibrate. Subarachnoid or subdural fluid-coupled devices and epidural ICP devices are currently less accurate. With an increasing miniaturization of the transducers, fiberoptic systems have been developed, however, there is a problem of measurement accuracy during the period of patient monitoring and external calibration should be performed frequently to ensure constant accuracy. Ventriculostomies continue to have a pivotal role in ICP control. With a rational understanding of the applications and limitations of the different ICP monitoring devices, the outcome for critically ill neurological patients is optimized.

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The present study was undertaken to ascertain the role of smooth muscles and pericytes in the microcirculation during hyperperfusion and hypoperfusion following ischemia in rats. Paired external carotids, the pterygopalatine branch of the internal carotids and the basilar artery were exposed and divided. Reversible inflatable occluders were placed around the common carotids. After 24 h, the unanesthetized rat underwent 10-min ischemia by inflating the occluders. Continuous cortical cerebral blood flow (c-CBF) was monitored by laser Doppler flowmetry. The measured c-CBF was below 20% of control (P < 0.001) during ischemia. A c-CBF of 227.5 +/- 54.1% (P < 0.001) was obtained during reperfusion hyperemia. A c-CBF of 59.7 +/- 8.8% (P < 0.001) occurred at the nadir of postischemic hypoperfusion, and this was followed by a second hyperemia. The cytoarchitecture of the vascular smooth muscles and pericytes was assessed by scanning electron microscopy. Samples were prepared using a KOH-collagenase digestion method. In control rats, arteriolar muscle cells showed smooth surfaces. Capillary pericytes were closely apposed to the endothelium. Immediately after reperfusion, transverse membrane creases were observed on the smooth muscle surfaces. During maximal hyperemia the creases disappeared. When c-CBF started to decrease the creases became visible again. Throughout the postischemic hypoperfusion the creases remained. Capillary endothelial walls became tortuous in the late phase of hypoperfusion. During the second hyperemia most arteriolar muscle cells showed smooth surfaces. Some pericytes appeared to have migrated from the vascular wall. The morphological changes of smooth muscle membranes suggest that they are related to specific perfusional disturbances during ischemia and reperfusion.

There are many materials available for the reconstruction of calvarial defects. Even though their biomaterial properties are well known, the biomechanical properties as part of the calvarium have not been investigated. In this article, calvarial implants are reviewed with their historic development into modern cranioplasty. Materials for trephined skulls are classified by their category. Individual parameters to describe their mechanical properties are collected and revealed in detail. The laboratory testing methodology for cranioplasty material is introduced to understand each parameter. At last, we discuss an engineering technique to look into the implant behavior. Since there is no standard goal for the biomechanical and biomaterial point of view for cranioplasty, this article suggests the finite element method for evaluation of the implant behavior and the degree of damage upon the impact injury.