Neurological Implications of Elevated Intra-Abdominal Pressure: A Narrative Review

Abstract

Objective: To deliver a comprehensive review of the anatomical, mechanical, and clinical dynamics connecting intra-abdominal pressure (IAP) to intracranial pressure (ICP), emphasizing their direct impacts on neurosurgical strategies, patient positioning, and critical care management.

Methods: A targeted literature search across PubMed and Embase was conducted. The text evaluates the complex interactions of raised intra-abdominal pressure (IAP) and abdominal compartment syndrome with cranio-spinal compliance pathways.

Results: The transmission of pathologic pressure is driven by two interdependent anatomical conduits: a thoracic-jugular route mediated by diaphragmatic translation, and a direct spine-to-cranium venous route routed through the valveless Batson’s vertebral plexus. Clinical evidence demonstrates that unrecognized IAP impairs neurocritical outcomes, reduces ventriculoperitoneal (VP) shunt efficacy, and amplifies epidural blood loss during prone-position spinal surgery.

Conclusion: Integrating routine IAP assessment, optimization of surgical tables, and targeted abdominal decompression are vital tenets of modern neuro trauma and neuro-anesthesia workflows required to stabilize intracranial compliance.