Data-Augmented Modeling of Intracranial Pressure

Abstract

Precise management of patients with cerebral diseases often requires intracranial pressure (ICP) monitoring, which is highly invasive and requires a specialized ICU setting. The ability to noninvasively estimate ICP is highly compelling as an alternative to, or screening for, invasive ICP measurement. Most existing approaches for noninvasive ICP estimation aim to build a regression function that maps noninvasive measurements to an ICP estimate using statistical learning techniques. These * data-based approaches have met limited success, likely because the amount of training data needed is onerous for this complex applications. In this work, we discuss an alternative strategy that aims to better utilize noninvasive measurement data by leveraging mechanistic understanding of physiology. Specifically, we developed a Bayesian framework that combines a multiscale model of intracranial physiology with noninvasive measurements of cerebral blood flow using transcranial Doppler. Virtual experiments with synthetic data are conducted to verify and analyze the proposed framework. A preliminary clinical application study on two patients is also performed in which we demonstrate the ability of this method to improve ICP prediction.

Noninvasive Cardiac Output and Central Systolic Pressure From Cuff-Pressure and Pulse Wave Velocity

“…Patient-specific modeling is an emerging field which promises to have a significant impact on clinical practice [22]. Data assimilation has significantly promoted patient-specific modeling and has become an area of increasing interest [23], [24].…”

Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring

“…Due to the somewhat complicated interplay between ICP, arterial pressure, and cerebral hemodynamics, a large number of methods have attempted to incorporate arterial pressure measurements, which may provide complementary information to assist in measuring ICP [125,154,155,[157][158][159][160][161][162][163][169][170][171][172][173][174][175]. These methods are not technically noninvasive as they require the placement of a radial artery catheter for monitoring ABP; however, this procedure is typically already performed as part of standard care in neurointesive care units, and the risks associated with monitoring ABP via radial artery catheter are considered significantly less risky than invasive ICP monitoring.…”

“…Attempting to combine aspects of both theory-based and data-based methods, Wang et al adopted a previously developed multiscale cerebrovascular model to simulate hidden intracranial states [173,176]. They then integrated patient specific TCD-based CBFV data into the model using a Bayesian data assimilation framework that employed a regularizing iterative ensemble Kalman filtering method to tune model parameters and calibrate ICP prediction [173]. This method was again validated initially against synthetic data before feasibility was demonstrated on two patients undergoing invasive ICP monitoring via EVD.…”

A Spectral Approach to Model-Based Noninvasive Intracranial Pressure Estimation

“…These model-based methods analyze the ABP and CBFV waveform measurements in the context of mechanistic models of the relevant cerebrospinal physiology. While such noninvasive ICP estimation has traditionally focused on estimating the mean ICP value, it has been suggested that the ICP pulse pressure or waveform morphology carry important diagnostic and prognostic information [31]- [33], and hence ICP pulse pressure or full waveform estimation has recently become the focus of attention as well [27], [30].…”