{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:35:12Z","timestamp":1792557312065,"version":"4.5.0"},"reference-count":70,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["RC-2025-2797257"],"award-info":[{"award-number":["RC-2025-2797257"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>In recent years, Transcranial Color Doppler (TCCD) has gained increasing recognition as a non-invasive neuromonitoring tool. However, there remains a strong tendency to view arterial TCCD as the \u2018stethoscope for the brain,\u2019 while the assessment of cerebral venous flow is still underrepresented in clinical protocols. This review aims to explore the emerging role of venous TCCD, particularly when combined with Internal Jugular Vein (IJV) ultrasound, in evaluating cerebral venous outflow in both critically ill and surgical patients. We conducted a narrative review of e-Pub articles from PubMed, MEDLINE, and Scopus, on the pathophysiological factors that impair cerebral venous drainage and their clinical implications in surgical and critical care settings. Based on this evidence, we developed two procedural algorithms that integrate established knowledge of cerebral venous hemodynamics with common clinical conditions affecting venous outflow, including internal jugular central venous catheter placement, mechanical ventilation, and pneumoperitoneum. The algorithms emphasize systematic monitoring of cerebral venous drainage, including assessment of internal jugular vein morphology and Rosenthal\u2019s vein flow, to guide procedural optimization and minimize potential neurological complications. They were informed by validated frameworks, such as the RaCeVa protocol, and are illustrated through two representative clinical case scenarios. Cerebral venous congestion can be induced by multiple established risk factors, including mechanical ventilation, cardiovascular disease, elevated intra-abdominal pressure, the Trendelenburg position, and central venous catheterization. In selected patients, real-time venous TCCD monitoring, combined with IJV assessment, allows early detection of cerebral venous outflow impairment and guides timely hemodynamic and procedural adjustments in both surgical settings and critical care contexts. Venous TCCD neuromonitoring may help prevent intracranial hypertension and its consequent neurological complications. It can guide clinical decisions during procedures that may compromise cerebral venous drainage, such as mechanical ventilation, the placement of large-bore central venous catheters, or laparoscopic and robot-assisted surgeries. Further studies are warranted to validate this strategy and better define its role in specific high-risk clinical scenarios.<\/jats:p>","DOI":"10.3390\/diagnostics16020289","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:39:37Z","timestamp":1768563577000},"page":"289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transcranial Color Doppler for Assessing Cerebral Venous Outflow in Critically Ill and Surgical Patients"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4509-0586","authenticated-orcid":false,"given":"Amedeo","family":"Bianchini","sequence":"first","affiliation":[{"name":"Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2603-8245","authenticated-orcid":false,"given":"Giovanni","family":"Vitale","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4512-4835","authenticated-orcid":false,"given":"Gabriele","family":"Melegari","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena, Via Pozzo 71, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cescon","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy"},{"name":"Hepato-Biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5862-6151","authenticated-orcid":false,"given":"Matteo","family":"Ravaioli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy"},{"name":"Hepato-Biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Zangheri","sequence":"additional","affiliation":[{"name":"Anesthesiology and Pain Therapy, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8905-9119","authenticated-orcid":false,"given":"Maria Francesca","family":"Scuppa","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Tigano","sequence":"additional","affiliation":[{"name":"Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Siniscalchi","sequence":"additional","affiliation":[{"name":"Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/CCM.0000000000005809","article-title":"Neuromonitoring in Critically Ill Patients","volume":"51","author":"Rajagopalan","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40477-018-0282-9","article-title":"Transcranial Doppler ultrasound in neurocritical care","volume":"21","author":"Blanco","year":"2018","journal-title":"J. Ultrasound"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2019.9.FOCUS19611","article-title":"Transcranial Doppler ultrasonography in neurological surgery and neurocritical care","volume":"47","author":"Bonow","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/jon.12887","article-title":"Transcranial Doppler to evaluate postreperfusion therapy following acute ischemic stroke: A literature review","volume":"31","author":"Shahripour","year":"2021","journal-title":"J. Neuroimaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e314","DOI":"10.1161\/STR.0000000000000436","article-title":"Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline from the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e169","DOI":"10.1097\/MAT.0000000000002312","article-title":"Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients: Extracorporeal Life Support Organization Consensus Guidelines","volume":"70","author":"Cho","year":"2024","journal-title":"ASAIO J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1212\/WNL.0000000000207740","article-title":"Pediatric and Adult Brain Death\/Death by Neurologic Criteria Consensus Guideline","volume":"101","author":"Greer","year":"2023","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"471","DOI":"10.23736\/S0021-9509.22.12368-2","article-title":"Guideline on carotid surgery for stroke prevention: Updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine","volume":"63","author":"Lanza","year":"2022","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/bja\/aex001","article-title":"Detection and differentiation of cerebral microemboli in patients undergoing major orthopaedic surgery using transcranial Doppler ultrasound","volume":"118","author":"Kietaibl","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/S0741-5214(95)70224-5","article-title":"The significance of microemboli detection by means of transcranial Doppler ultrasonography monitoring in carotid endarterectomy","volume":"21","author":"Ackerstaff","year":"1995","journal-title":"J. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bianchini, A., Vitale, G., Romano, S., Sbaraini Zernini, I., Galeotti, L., Cescon, M., Ravaioli, M., and Siniscalchi, A. (2024). Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery. Appl. Sci., 14.","DOI":"10.3390\/app14114590"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1093\/icvts\/ivx357","article-title":"Cerebral autoregulation in cardiopulmonary bypass surgery: A systematic review","volume":"26","author":"Caldas","year":"2018","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Thudium, M., Ellerkmann, R.K., Heinze, I., and Hilbert, T. (2019). Relative cerebral hyperperfusion during cardiopulmonary bypass is associated with risk for postoperative delirium: A cross-sectional cohort study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0705-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/j.ultrasmedbio.2019.02.003","article-title":"Transcranial Doppler Non-invasive Assessment of Intracranial Pressure, Autoregulation of Cerebral Blood Flow and Critical Closing Pressure during Orthotopic Liver Transplant","volume":"45","author":"Cardim","year":"2019","journal-title":"Ultrasound Med. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1111\/jon.13013","article-title":"ASNM and ASN joint guidelines for transcranial Doppler ultrasonic monitoring: An update","volume":"32","author":"Razumovsky","year":"2022","journal-title":"J. Neuroimaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s00134-021-06486-z","article-title":"Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: Consensus and expert recommendations of the European Society of Intensive Care Medicine","volume":"47","author":"Robba","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1080\/17476348.2024.2438088","article-title":"Optimizing protective ventilation in adults with acute brain injury-challenging misconceptions and prioritizing neuromonitoring","volume":"18","author":"Goossen","year":"2024","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1002\/jnr.24148","article-title":"Transcranial Doppler: A stethoscope for the brain-neurocritical care use","volume":"96","author":"Robba","year":"2018","journal-title":"J. Neurosci. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1177\/0271678X16648711","article-title":"Monro-Kellie. 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure","volume":"36","author":"Wilson","year":"2016","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/19714009211029261","article-title":"A proposed framework for cerebral venous congestion","volume":"35","author":"Arun","year":"2022","journal-title":"Neuroradiol. J."},{"key":"ref_21","first-page":"1180","article-title":"Vascular hydraulics associated with idiopathic and secondary intracranial hypertension","volume":"23","author":"Bateman","year":"2002","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.hest.2024.03.002","article-title":"Cerebral venous impairment and cerebral venous sinus thrombosis","volume":"5","author":"Wang","year":"2024","journal-title":"Brain Hemorrhages"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1161\/01.STR.0000016507.94646.E6","article-title":"Intracranial venous hemodynamics is a factor related to a favorable outcome in cerebral venous thrombosis","volume":"33","author":"Stolz","year":"2002","journal-title":"Stroke"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1024\/0301-1526\/a001028","article-title":"Intracranial pressure and veins","volume":"51","author":"Stolz","year":"2022","journal-title":"Vasa"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"744","DOI":"10.3171\/jns.1999.91.5.0744","article-title":"The impact of raised intracranial pressure on cerebral venous hemodynamics: A prospective venous transcranial Doppler ultrasonography study","volume":"91","author":"Schoser","year":"1999","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1111\/j.1552-6569.2002.tb00140.x","article-title":"Blood flow velocities in the basal cerebral vein after head trauma: A prospective study in 82 patients","volume":"12","author":"Mursch","year":"2002","journal-title":"J. Neuroimaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1161\/01.STR.0000132195.17366.2b","article-title":"Cerebral venous flow velocity predicts poor outcome in subarachnoid hemorrhage","volume":"35","author":"Niesen","year":"2004","journal-title":"Stroke"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s007010170033","article-title":"Blood flow velocities in the basal vein after subarachnoid haemorrhage. A prospective study using transcranial duplex sonography","volume":"143","author":"Mursch","year":"2001","journal-title":"Acta Neurochir."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Pan, Y., Wan, W., Xiang, M., and Guan, Y. (2022). Transcranial Doppler Ultrasonography as a Diagnostic Tool for Cerebrovascular Disorders. Front. Hum. Neurosci., 16.","DOI":"10.3389\/fnhum.2022.841809"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.3171\/2017.5.JNS17232","article-title":"Assessment of intracranial venous blood flow after subarachnoid hemorrhage: A new approach to diagnose vasospasm with transcranial color-coded duplex sonography","volume":"129","author":"Connolly","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.ultrasmedbio.2007.05.018","article-title":"Transient global amnesia: Cerebral venous outflow impairment-insight from the abnormal flow patterns of the internal jugular vein","volume":"33","author":"Chung","year":"2007","journal-title":"Ultrasound Med. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez, C.N., Baracchini, C., Mejia-Mantilla, J.H., Czosnyka, M., Suarez, J.I., Csiba, L., Puppo, C., and Bartels, E. (2022). Arteriovenous Malformation (AVM) and Arteriovenous Fistula in the ICU: Contributions of Transcranial Doppler (TCD\/TCCS) to Diagnosis. Neurosonology in Critical Care, Springer.","DOI":"10.1007\/978-3-030-81419-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"109255","DOI":"10.1016\/j.mehy.2019.109255","article-title":"Fluid dynamics of cerebrospinal venous flow in multiple sclerosis","volume":"131","author":"Tucker","year":"2019","journal-title":"Med. Hypotheses"},{"key":"ref_34","first-page":"e62048","article-title":"Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow","volume":"169","author":"Hage","year":"2021","journal-title":"J. Vis. Exp."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/1129729818804718","article-title":"Rapid Central Vein Assessment (RaCeVA): A systematic, standardized approach for ultrasound assessment before central venous catheterization","volume":"20","author":"Spencer","year":"2019","journal-title":"J. Vasc. Access"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1513\/AnnalsATS.201704-332CME","article-title":"Summary for Clinicians: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome Clinical Practice Guideline","volume":"14","author":"Weiss","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_37","first-page":"588","article-title":"The impact of positive end-expiratory pressure on cerebral perfusion pressure and hemodynamics in patients receiving lung recruitment maneuver","volume":"20","author":"Yang","year":"2008","journal-title":"Chin. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/ANA.0b013e31828bac4d","article-title":"Effects of positive end expiratory pressure (PEEP) on intracranial and cerebral perfusion pressure in pediatric neurosurgical patients","volume":"25","author":"Pulitano","year":"2013","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1007\/s00134-020-06283-0","article-title":"Mechanical ventilation in patients with acute brain injury: Recommendations of the European Society of Intensive Care Medicine consensus","volume":"46","author":"Robba","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Bianchini, A., Pintus, L., Vitale, G., Mazzotta, E., Felicani, C., Zangheri, E., Latrofa, M.E., Modolon, C., Pisano, R., and Siniscalchi, A. (2025). Lung Ultrasound in Mechanical Ventilation: A Purposive Review. Diagnostics, 15.","DOI":"10.3390\/diagnostics15070870"},{"key":"ref_41","first-page":"835","article-title":"Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome","volume":"131","author":"Bradley","year":"1985","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_42","unstructured":"Jan, M.F., and Tajik, A.J. (2019). Diagnosing and managing pulmonary and right-sided heart disease: Pulmonary hypertension, right ventricular outflow pathology, and sleep apnea. Hypertrophic Cardiomyopathy, Springer."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1161\/hs1101.098360","article-title":"Cerebral blood flow in patients with chronic heart failure before and after heart transplantation","volume":"32","author":"Gruhn","year":"2001","journal-title":"Stroke"},{"key":"ref_44","unstructured":"Demonte, G., Santangelo, D., Roccia, F., Gambardella, A., and Bono, F. (2019, January 5\u20138). Obstructive sleep apnea (OSA) in headache sufferers with Idiopathic intracranial Hypertension (IIH): A prospective study. Proceedings of the 19th Conference of the International Headache Conference, Dublin, Ireland."},{"key":"ref_45","first-page":"110","article-title":"Abdominal compartment syndrome","volume":"12","author":"Berry","year":"2012","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1097\/00005373-199406000-00011","article-title":"Diagnostic laparoscopy increases intracranial pressure","volume":"36","author":"Josephs","year":"1994","journal-title":"J. Trauma"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1212\/WNL.49.2.507","article-title":"Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri","volume":"49","author":"Sugerman","year":"1997","journal-title":"Neurology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1007\/s00701-021-04866-4","article-title":"Superior sagittal sinus-to-internal jugular vein bypass shunt with covered stent construct for intractable intracranial hypertension resulting from iatrogenic supratorcular sinus occlusion","volume":"163","author":"Sattur","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.1016\/S0272-6386(98)70065-4","article-title":"Pseudotumor cerebri: An unusual complication of brachiocephalic vein thrombosis associated with hemodialysis catheters","volume":"31","author":"Molina","year":"1998","journal-title":"Am. J. Kidney Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1002\/hed.2890100708","article-title":"Pseudotumor cerebri following spontaneous internal jugular vein thrombosis","volume":"10","author":"Benninger","year":"1988","journal-title":"Head Neck"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1080\/00016480310000764","article-title":"Venous drainage patterns in a case of pseudotumor cerebri following unilateral radical neck dissection","volume":"123","author":"Doepp","year":"2003","journal-title":"Acta Otolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1007\/s00415-009-5056-z","article-title":"Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension","volume":"256","author":"Nedelmann","year":"2009","journal-title":"J. Neurol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Yang, B., Li, M., Liang, J., Tang, X., and Chen, Q. (2023). Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1199931"},{"key":"ref_54","first-page":"e000522","article-title":"Head Elevation, Cerebral Venous System, and Intracranial Pressure: Review and Hypothesis","volume":"3","author":"Sattur","year":"2023","journal-title":"Stroke Vasc. Interv. Neurol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1378\/chest.10-2637","article-title":"The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters","volume":"140","author":"Nifong","year":"2011","journal-title":"Chest"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"429","DOI":"10.4103\/joacp.joacp_531_21","article-title":"Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study","volume":"39","author":"Joseph","year":"2023","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1007\/s12028-024-02020-3","article-title":"The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis","volume":"41","author":"Ramos","year":"2024","journal-title":"Neurocrit. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1007\/s00701-023-05620-8","article-title":"ICP during head movement: Significance of the venous system","volume":"165","author":"Khawari","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/bja\/aex003","article-title":"Complications of robotic-assisted laparoscopic surgery distant from the surgical site","volume":"118","author":"Maerz","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4285\/ctr.24.0007","article-title":"Perioperative optic nerve sheath diameter variations in patients with end-stage renal failure undergoing robotic-assisted kidney transplant: A prospective observational study","volume":"38","author":"Rajmohan","year":"2024","journal-title":"Clin. Transpl. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4103\/1658-354X.154693","article-title":"Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position","volume":"9","author":"Shah","year":"2015","journal-title":"Saudi J. Anaesth."},{"key":"ref_62","first-page":"416","article-title":"The effect of laparoscopy on intracranial pressure as measured by optic nerve sheath diameter: A review","volume":"63","author":"Mitchell","year":"2022","journal-title":"Can. Vet. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.bjan.2020.06.006","article-title":"N\u00edvel de S100B e disfun\u00e7\u00e3o cognitiva ap\u00f3s prostatectomia radical laparosc\u00f3pica assistida por rob\u00f4: Estudo observational prospectivo [S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: A prospective observational study]","volume":"70","author":"Kavakli","year":"2020","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.urology.2019.12.045","article-title":"Comparison of Cognitive Function After Robot-Assisted Prostatectomy and Open Retropubic Radical Prostatectomy: A Prospective Observational Single-Center Study","volume":"139","author":"Beck","year":"2020","journal-title":"Urology"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Li, Y., Huang, D., Su, D., Chen, J., and Yang, L. (2019). Postoperative cognitive dysfunction after robot-assisted radical cystectomy (RARC) with cerebral oxygen monitoring an observational prospective cohort pilot study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0877-5"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s00404-014-3355-9","article-title":"Cerebral oedema following robotic surgery: A rare complication","volume":"290","author":"Barr","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1161\/01.STR.27.7.1221","article-title":"Assessment of normal flow velocity in basal cerebral veins. A transcranial doppler ultrasound study","volume":"27","author":"Valdueza","year":"1996","journal-title":"Stroke"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1161\/01.STR.27.7.1177","article-title":"Evaluation of impaired cerebral autoregulation by the Valsalva maneuver","volume":"27","author":"Tiecks","year":"1996","journal-title":"Stroke"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00421-010-1411-0","article-title":"Active regulation of cerebral venous tone: Simultaneous arterial and venous transcranial Doppler sonography during a Valsalva manoeuvre","volume":"109","author":"Stolz","year":"2010","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s13054-025-05384-w","article-title":"From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: Can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study","volume":"29","author":"Mariani","year":"2025","journal-title":"Crit. 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