Intracranial pressure reserve testing. A study in experimental animals

H. A. Wilkinson, D. Arredondo, S. Weems and D. Kaner

Quantitating cerebral "elastance" or "ICP reserve" has added considerably to the value of continuous monitoring of intracranial pressure (ICP). Intracranial pressure reserve is a measure of the capacity of the brain's natural compensatory mechanisms for countering increases in ICP secondary to increases in intracranial volume. Intracranial pressure reserve testing was studied in dogs with known volumes of extracerebral intracranial mass, both in normal and in edematous brains and at various ICPs. Ten thousand measurements were made with five different methods of measuring ICP reserve. Testing when multiple increments of subdural saline infusion were used over a five-minute period to quantitate ICP reactivity to volumetric stress seemed most reliable and most adaptable to clinical application. Methods of measuring cerebral "elastance" using only a single subdural infusion proved to be variable and difficult to read.