Intracranial pressure management in severe intraventricular hemorrhage: A minireview

Severe intraventricular hemorrhage (IVH) is a life-threatening neurological emergency that poses significant risks of morbidity and mortality, particularly due to the associated elevated intracranial pressure (ICP). Studies have shown that the incidence of IVH in very preterm infants is high, with management strategies playing a significant role in its development. Moreover, predictive models have been developed to forecast early mortality and severe IVH in very-low birth weight preterm infants, indicating the complexity and multifactorial nature of this condition. This mini-review synthesizes recent advances in the understanding of intracranial dynamics, monitoring technologies, and therapeutic strategies for managing ICP in IVH. The Monro-Kellie 4.0 framework integrates cerebrovascular autoregulation, intracranial compliance, and glymphatic clearance as core determinants of ICP. Pathophysiological mechanisms include obstructive hydrocephalus, hemoglobin-mediated neurotoxicity, and cortical spreading depolarizations. Advancements in non-invasive monitoring techniques, such as ICP monitoring and genetic testing, coupled with the integration of artificial intelligence, are significantly improving early detection capabilities and enabling more personalized management strategies. Therapeutic advances include algorithmic cerebrospinal fluid drainage, glymphatic-enhanced therapies, and precision hyperosmolar therapy. This review highlights the need for standardized protocols, large-scale trials, and artificial intelligence-driven approaches to improve outcomes in severe IVH.