Ultrasonography Assessments of Optic Nerve Sheath Diameter as a Noninvasive and Dynamic Method of Detecting Changes in Intracranial Pressure

Abstract

IMPORTANCE The crtierion standard method for monitoring intracranial pressure (ICP) can result in complications and pain. Hence, noninvasive, repeatable methods would be valuable. OBJECTIVE To examine how ultrasonographic optic nerve sheath diameter (ONSD) correlated with noninvasive and dynamically monitored ICP changes. DESIGN, SETTING, AND PARTICIPANTS The ONSD was measured before the lumbar puncture (LP) in 60 patients on admission. Patients with elevated ICP were divided into group 1 (200 < LP Յ 300 mm H 2 O) and group 2 (LP > 300 mm H 2 O). Patients underwent follow-up ONSD and LP measurements within 1 month. We analyzed the correlations between the ONSD and ICP on admission and between the changes in ONSD and ICP, which were the respective changes in ONSD and ICP from admission to follow-up. MAIN OUTCOMES AND MEASURES The ultrasonographic ONSD and ICP were measured on admission and follow-up. The correlations between the ONSD and ICP on admission and between the changes in ONSD and ICP were analyzed using Pearson correlation analyses. RESULTS For 60 patients (Han nationality; mean [SD] age, 36.2 [12.04] years; 29 [48%] female) on admission, the ONSD and ICP values were strongly correlated, with an r of 0.798 (95% CI, 0.709-0.867; P < .001). Twenty-five patients with elevated ICP who completed the follow-up were included. The mean (SD) ONSD and ICP on admission were 4.50 (0.54) mm and 302.40 (54.26) mm H 2 O, respectively. The ONSD and ICP values obtained on admission were strongly correlated , with an r of 0.724 (95% CI, 0.470-0.876; P < .001). The mean (SD, range) changes in ICP and ONSD were 126.64 (52.51 mm H 2 O, 20-210 mm H 2 O) (95% CI, 106.24-146.07) and 1.00 (0.512 mm, 0.418-2.37 mm) (95% CI, 0.83-1.20), respectively. The change in ONSD was strongly correlated with the change in ICP, with an r of 0.702 (95% CI, 0.425-0.870; P < .001). The follow-up evaluations revealed that the elevated ICP and dilated ONSD had returned to normal, and no evidence of difference was found in the mean ONSDs between group 1 (3.49 mm; 95% CI, 3.34-3.62 mm) and group 2 (3.51 mm; 95% CI, 3.44-3.59 mm) (P = .778) at follow-up. CONCLUSIONS AND RELEVANCE The dilated ONSDs decreased along with the elevated ICP reduction. Ultrasonographic ONSD measurements may be a useful, noninvasive tool for dynamically evaluating ICP.

Optic Nerve Sheath Diameter in retrobulbar ultrasound as a surrogate measure for intracranial pressure before and after non-invasive strategies.

“…20 A previous study published by Launey and colleagues in 2014 22 that included invasive measurements of ICP through an intraventricular catheter and the ONSD before and after using 20% mannitol, found that both measures decreased significantly after using such therapy. Also Wang and co-workers in 2018 23 in his study where they measured the ICP through lumbar puncture and also the ONSD was recorded before and after using etiological and osmotic treatment, with a follow up for 1 month, shows that ICP changes in an invasive an non-invasive way were highly related.…”

Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series

“…If the changes in either pEEG monitoring or cerebral saturation are unilateral, and the peripheral or somatic NIRS saturation is normal, localized cerebral hypoperfusion should be suspected. Furthermore, cerebral investigation should be pursued, such as a carotid, jugular, and brain ultrasound, TCD, 15 optic nerve sheath measurement, 16,17 and/or computed tomography. On the other hand, if the cerebral saturation reduction is bilateral and symmetrical and the somatic NIRS saturation is also reduced, then a non-cerebral etiology such as cardiogenic shock, hemorrhagic shock, hypoxemia or obstruction to adequate central venous drainage (superior or inferior vena cava) is more likely, as previously reported.…”

Current concepts of cerebrospinal fluid dynamics and the translaminar cribrosa pressure gradient: a paradigm of optic disk disease

“…162 In addition, changes in ICP correlate with reciprocal changes in optic nerve sheath diameter. 198 Similarly, a magnetic resonance imagingeassisted measurement of the width of the orbital SAS has been used to estimate ICP. 204 Finally, venous ophthalmodynamometry has been used to correlate central retinal venous pressure with ICP.…”