Brasil Sérgio, Patriota Gustavo C, Godoy Daniel Agustín, Paranhos Jorge L, Rubiano Andrés Mariano, Paiva Wellingson S
Experimental Surgery Laboratory, Division of Neurological Surgery, University of São Paulo Medical School, São Paulo, Brazil.
Department of Neurosurgery, Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa, Brazil.
Crit Care. 2025 Jun 5;29(1):229. doi: 10.1186/s13054-025-05476-7.
The Monro-Kellie doctrine, introduced in the late 18th century, was a groundbreaking concept aimed at explaining the interactions between intracranial volume components. It has since become a cornerstone of brain physiology, now recognized as intracranial dynamics. Initially, the doctrine focused on physiological observations of the three incompressible components of the cranial vault: brain tissue, blood, and cerebrospinal fluid (CSF). Over the centuries, advancements in neuroscience and medical technology have deepened our understanding of intracranial pressure (ICP) regulation, its pathophysiological implications and its role in neurological disorders. This revisitation of the Monro-Kellie doctrine examines how impairments in cerebrovascular autoregulation, brain compartmentalization and the glymphatic system interact in severely brain-injured patients, calling for new management strategies when facing these critical situations. Additionally, it reinforces the need for a holistic monitoring approach to improve early diagnostics and intervention. The evolution of ICP assessment has significantly shaped the management of brain trauma, spontaneous bleeding, ischemic stroke, and hydrocephalus. With the introduction of innovative tools such as brain ultrasound, automated pupillometry and noninvasive pressure waveform monitoring, ICP management is shifting toward more accessible and continuous evaluation strategies. This review explores how blending historical principles with cutting-edge innovations is transforming neuromonitoring and enhancing patient outcomes in critical care.
18世纪末提出的孟罗-凯利学说，是一个具有开创性的概念，旨在解释颅内各容积成分之间的相互作用。从那时起，它已成为脑生理学的基石，如今被视为颅内动力学。最初，该学说专注于对颅腔三个不可压缩成分的生理学观察：脑组织、血液和脑脊液（CSF）。几个世纪以来，神经科学和医疗技术的进步加深了我们对颅内压（ICP）调节、其病理生理学意义及其在神经系统疾病中作用的理解。对孟罗-凯利学说的这次重新审视，探讨了脑血管自动调节、脑分隔和类淋巴系统的损伤在重度脑损伤患者中是如何相互作用的，呼吁在面对这些危急情况时采用新的管理策略。此外，它强化了采用整体监测方法以改善早期诊断和干预的必要性。颅内压评估的演变显著地塑造了脑外伤（脑创伤）、自发性出血、缺血性中风和脑积水的管理方式。随着脑超声、自动瞳孔测量和无创压力波形监测等创新工具的引入，颅内压管理正朝着更易于实施和持续评估的策略转变。这篇综述探讨了如何将历史原则与前沿创新相结合，正在改变神经监测并改善重症监护中的患者预后。
