{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:29:11Z","timestamp":1790666951939,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Morphological alterations in intracranial pressure (ICP) pulse waveform (ICPW) secondary to intracranial hypertension (ICP &gt;20 mmHg) and a reduction in intracranial compliance (ICC) are well known indicators of neurological severity. The exclusive exploration of modifications in ICPW after either the loss of skull integrity or surgical procedures for intracranial hypertension resolution is not a common approach studied. The present study aimed to assess the morphological alterations in ICPW among neurocritical care patients with skull defects and decompressive craniectomy (DC) by comparing the variations in ICPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of acute brain injury were included. A continuous record of 10 min-length for the beat-by-beat analysis of ICPW was performed, with ICP elevation produced by means of ultrasound-guided manual internal jugular vein compression at the end of the record. ICPW features (peak amplitude ratio (P2\/P1), time interval to pulse peak (TTP) and pulse amplitude) were counterweighed between baseline and compression periods. Results were distributed for three groups: intact skull (exclusive burr hole for ICP monitoring), craniotomy\/large fractures (group 2) or DC (group 3). Results: 57 patients were analyzed. A total of 21 (36%) presented no skull defects, 21 (36%) belonged to group 2, whereas 15 (26%) had DC. ICP was not significantly different between groups: \u00b115.11 for intact, 15.33 for group 2 and \u00b120.81 mmHg for group 3, with ICP-induced elevation also similar between groups (p = 0.56). Significant elevation was observed for the P2\/P1 ratio for groups 1 and 2, whereas a reduction was observed in group 3 (elevation of \u00b10.09 for groups 1 and 2, but a reduction of 0.03 for group 3, p = 0.01), and no significant results were obtained for TTP and pulse amplitudes. Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPW indicated DC to be protective for further influences of ICP elevations over the brain. The analysis of ICPW seems to be an alternative to real-time ICC assessment.<\/jats:p>","DOI":"10.3390\/brainsci11080971","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T10:31:44Z","timestamp":1627036304000},"page":"971","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2397-9947","authenticated-orcid":false,"given":"S\u00e9rgio","family":"Brasil","sequence":"first","affiliation":[{"name":"Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davi Jorge Fontoura","family":"Solla","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo de Carvalho","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7974-6045","authenticated-orcid":false,"given":"Manoel","family":"Jacobsen Teixeira","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Marcelo S\u00e1","family":"Malbouisson","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-7040","authenticated-orcid":false,"given":"Wellingson Silva","family":"Paiva","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"940","DOI":"10.3389\/fphys.2018.00940","article-title":"Cerebrovascular Compliance Within the Rigid Confines of the Skull","volume":"9","author":"Zamir","year":"2018","journal-title":"Front. 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