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Abstract

Background: Intracranial pressure (ICP) monitoring is a guideline-endorsed component of severe traumatic brain injury (sTBI) care, yet implementation in China remains variable. Methods: We conducted a nationwide cross-sectional survey of neurosurgeons (September 2025) to assess institutional capacity, ICP practice patterns, perceived barriers, and training needs. Descriptive statistics summarized distributions; scenario-specific barriers (ICP monitoring at the time of decompressive craniectomy/craniotomy pathway and pre-operative ICP monitoring without immediate surgery pathway) were contrasted to implementation. Results: Of 321 returns, 292 valid responses were analyzed. Most respondents worked in Tertiary-A hospitals (75.7%). Most hospitals of respondents had independent neurosurgery departments (96.6%) and dedicated neuro-ICUs (77.7%). ICP equipment was fully sufficient in 57.2% of respondents, partially sufficient in 33.6% of respondents, and unavailable in 9.2% of respondents. For ICP monitoring at the time of decompressive craniectomy pathway, 59.2% reported attempting ICP monitoring whenever feasible, 37.7% selectively did and 3.1% never did so. For pre-operative ICP monitoring without immediate surgery pathway, 46.6% attempted pre-operative ICP monitoring whenever feasible and 44.9% selectively did. Scenario-specific barriers prominently included DRG/DIP constraints (87.3% in ICP monitoring at the time of decompressive craniectomy/craniotomy scenario; 88.4% in pre-operative ICP monitoring without immediate surgery scenario) and patient affordability (75.3% and 76.7%, respectively). In overall obstacles, DRG/DIP cost exceedance, patient affordability, and lack of standardized training predominated. Only 36.0% received structured procedural training before first independent ICP insertion; 22.9% received more than 5 training cases in ICP insertion. Among those favoring probe-based monitoring (87.7%), ventricular placement was preferred (67.6% of probe users). Infection and tract hemorrhage ranked as the leading complications of concern. Interest in capacity building prioritized proctorship/mentorship and high-fidelity simulation, with top content needs in standardized operative technique (87.3%), dynamic data interpretation (71.2%), and complication prevention/management (70.5%). Conclusions: Low and heterogeneous ICP monitoring implementation reflects intersecting financing, resource, and training barriers. Standardized, stepwise ICP probe/EVD-Based ICP Monitoring multidisciplinary training (including nursing), policy reform of DRG/DIP reimbursement, and targeted procurement strategies are essential to increase safe, equitable ICP monitoring. [An updated file with minor revisions was uploaded on 2025-10-22.]