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Increased Intracranial Pressure ll: Pathophysiology

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...

Increased Intracranial Pressure l: Introduction

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...

Aneurysm II: Clinical Manifestations and Diagnostic Studies

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Cranial and Spinal Meninges

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Related Experiment Video

Updated: May 19, 2026

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Published on: November 8, 2024

Controversies in Chiari I malformations.

Jamie Baisden¹

¹Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, WI, USA.

Surgical Neurology International

|August 21, 2012

Summary

Chiari I malformation (CMI) diagnosis and treatment are debated, especially for incidental findings. Surgery is recommended for symptomatic CMI with cerebrospinal fluid (CSF) blockage, requiring careful patient selection.

Keywords:

Chiari malformation I decompression duroplasty operative controversy suboccipital craniectomy surgical indications

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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

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Published on: July 5, 2021

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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

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Published on: November 8, 2024

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Area of Science:

Neurosurgery
Neurology
Neuroradiology

Background:

Chiari I malformation (CMI) diagnosis and management remain controversial, often found incidentally during MR scans for neck pain or headaches.
Over-operation on asymptomatic patients or those lacking diagnostic radiographic features for CMI has occurred, with limited accountability.
Symptomatic CMI, characterized by impaired cerebrospinal fluid (CSF) circulation, necessitates valid surgical management strategies.

Purpose of the Study:

To review the current literature on the clinical presentation, diagnosis, and surgical management of Chiari I malformation.
To present and critique variations in surgical techniques for CMI.

Main Methods:

Literature review focusing on clinical presentation, diagnosis, and surgical management of Chiari I malformation.
Analysis of variations in surgical techniques and their outcomes.

Main Results:

Decompressive suboccipital craniectomy and duroplasty are recommended for Chiari I malformations.
This treatment is indicated when preoperative abnormal cine-flow MRI shows persistent blockage of CSF flow intraoperatively, even after bony decompression.

Conclusions:

Optimal surgical techniques for Chiari malformations I continue to be debated.
Accurate diagnostic studies and judicious patient selection are crucial for improving outcomes and preventing unnecessary surgeries.