Intracranial pressure (ICP) is derived from cerebral blood and CSF circulatory dynamics, in pathology having also strong component related to volumetric changes in brain tissue or lesions. It can be affected in a course of many diseases of central nervous system. Monitoring of ICP requires an invasive transducer, although some attempts to measure it non-invasively have been made. Because of its dynamic nature, instant CSF pressure measurement using the height of a fluid column via lumbar puncture may be misleading. An averaging over 30 min with should be the minimum, with a period of overnight monitoring in conscious patients providing optimal standard. Computer-aided recording with on-line waveform analysis of ICP is very helpful.

Recent trial BestTRIP has been unfortunately badly designed and conducted, therefore it was unable to bring constructive message. Although there is no positive ‘Class I’ evidence, ICP monitoring is useful, if not essential, in head injury, poor grade subarachnoid haemorrhage, stroke, intracerebral haematoma, meningitis, acute liver failure, hydrocephalus, benign intracranial hypertension, craniosynostosis, etc. Information which can be derived from ICP and its waveforms include cerebral perfusion pressure, regulation of cerebral blood flow and volume, CSF absorption capacity, brain compensatory reserve, content of vasogenic events. Some of these parameters allows prognosis of survival following head injury and optimisation of ‘CPP-guided therapy’.