Real-Time Assessment of Intracranial Pressure Using a Non-Invasive Wearable Acoustic Sensor Array Calibrated with Lumbar Puncture Data

Continuous monitoring of intracranial pressure (ICP) is vital for managing traumatic brain injury, hydrocephalus, and severe cerebrovascular events. Conventional invasive techniques, including intraventricular catheters and parenchymal probes, carry substantial risks of infection, hemorrhage, and mechanical failure, while diagnostic lumbar punctures (LPs) provide only single time-point snapshots. In this work, we present a novel, non-invasive wearable acoustic sensor array capable of real-time ICP estimation. The system utilizes low-frequency multi-channel piezoelectric transducers embedded in a flexible conformal headband to capture subtle variations in transcranial acoustic transmission velocity and harmonic resonance profiles induced by changes in intracranial compliance. A cohort of 42 adult patients undergoing diagnostic lumbar puncture was recruited to calibrate and validate the acoustic estimation algorithm. The non-invasive acoustic system demonstrated a strong linear correlation with opening LP pressures (Pearson’s r = 0.91, p < 0.001) with a mean absolute error of 1.74 ± 0.42 mmHg and a Bland-Altman 95% limit of agreement between −3.62 and +3.88 mmHg across a pressure range of 6 to 34 mmHg. Dynamic posture-change experiments confirmed the device’s ability to track rapid transient fluctuations in cerebrospinal fluid dynamics with millisecond temporal resolution. These findings demonstrate that wearable acoustic sensing provides a robust, operator-independent, and safe alternative for continuous ICP tracking in both emergency and ambulatory clinical environments.