Advances in monitoring the injured brain.

Abstract

Multimodal neuromonitoring has emerged as a cornerstone of modern neurocritical care for traumatic brain injury (TBI). Traditional monitoring approaches based on intracranial pressure (ICP) and clinical examination alone have proven insufficient to capture the complex, heterogeneous pathophysiology that drives secondary brain injury. Over the past decade, significant advances in monitoring technology, including brain tissue oxygenation, cerebral microdialysis, continuous electroencephalography, near‑infrared spectroscopy, cerebrovascular autoregulation assessment and non‑invasive techniques have enabled clinicians to individualize treatment strategies based on real‑time physiological data. Concurrently, artificial intelligence and machine learning are transforming data integration and prognostic modelling, and non‑invasive and wearable approaches are beginning to extend brain monitoring beyond high‑resource neuro‑ICUs. This review examines recent innovations in neuromonitoring for TBI, highlighting invasive and non‑invasive modalities, their integration into multimodal platforms, and emerging technologies that promise to make precision neurocritical care a clinical reality. As we move toward the future of neurosurgery, the challenge lies not only in developing advanced monitoring tools but in interpreting them in the context of host‑specific factors and translating complex physiological signals into timely, evidence‑based interventions that improve patient outcomes.