Multimodal assessment of intracranial hypertension: invasive and non-invasive monitoring strategies in neurocritical care

Intracranial hypertension (IH) is a life-threatening condition commonly associated with traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), leading to decreased cerebral perfusion and secondary brain damage. Accurate intracranial pressure (ICP) monitoring is essential to guide therapeutic decisions and prevent adverse neurological outcomes. This narrative review aims to describe and compare the main modalities for ICP assessment, including invasive, non-invasive, and multimodal strategies. Literature was searched in PubMed, Scopus, and Web of Science for studies published between 2010 and 2025. Invasive techniques, such as ventricular catheters and parenchymal probes, remain the gold standard due to their precision and ability to drain cerebrospinal fluid. Non-invasive methods, including transcranial Doppler and optic nerve sheath ultrasound, demonstrate good correlation with invasive ICP values while minimizing infection and bleeding risks. The integration of these tools into multimodal frameworks—combining hemodynamic, metabolic, and neuroimaging parameters—enables early detection of intracranial hypertension and individualized management. In conclusion, multimodal and continuous ICP monitoring represents a modern and safer approach in neurocritical care, promoting real-time physiologic assessment and evidence-based decision-making.