ReviewBrain & spine2026
Systematic review of the diagnostic accuracy of noninvasive intracranial pressure monitoring using optic nerve sheath diameter and the Brain4Care system.
Review in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Assessing the intracranial pressure (ICP) with accuracy is essential in management of acute brain injury. Invasive monitoring remains the gold standard but carries procedural risks and requires neurosurgical competence. Noninvasive methods such as optic nerve sheath diameter (ONSD) ultrasonography and the Brain4Care (B4C) system have emerged as potential alternatives for estimating ICP or intracranial compliance. Methods: A systematic search of PubMed and Cochrane Library was conducted for studies published up to October 2025 evaluating ONSD or B4C against invasive ICP monitoring in adult patients. Data on diagnostic performance, including sensitivity, specificity and correlation with invasive ICP, were extracted and summarized. Results: A total of 47 studies was included, comprising 36 ONSD and 11 B4C investigations. ONSD cut-offs ranged from 4.1 to 7.2 mm, most commonly between 5.0 and 5.9 mm. Reported sensitivities were 70-100%, specificities 70-100% and correlation coefficients r = 0.64-0.90 with invasive ICP. B4C studies evaluated the P2/P1 ratio and time-to-peak (TTP) parameters, with sensitivities of 70-100% and specificities 41-92%. While some studies demonstrated strong correlations with invasive ICP (r up to 0.98), others reported modest accuracy and low specificity, emphasizing dependence on waveform quality and patient population. Conclusion: ONSD currently remains as the most validated noninvasive method for estimating raised ICP, demonstrating consistently high diagnostic accuracy across studies. The B4C system shows promise for continuous, noninvasive monitoring of intracranial compliance but requires further validation in larger, multicenter settings.
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