Association of optic nerve sheath diameter with direct intracranial pressure measurement in neurosurgical patients
DOI:
https://doi.org/10.3126/jkmc.v11i2.48671Keywords:
External ventricular drain, Intracranial pressure , Ocular ultrasound , Optic nerve sheath diameterAbstract
Background: Invasive intracranial devices are gold standard for measurement of intracranial pressure (ICP), however optic nerve sheath diameter (ONSD) by using ultrasound is emerging lately as a non-invasive bedside tool.
Objectives: This study aimed to find association between ONSD and invasive ICP and also to find optimum cut off of ONSD to detect raised ICP.
Methods: An analytical observational study using a convenience sample was done at Department of Neurosurgery, Kathmandu Medical College from March 1, 2022 and March 31, 2022. The ONSD of both the eyes were measured using ultrasound in patients with ventriculostomy catheter. Simultaneous ICP was also recorded. The Pearson’s correlation coefficient was used to assess an association between the ONSD and direct ICP measurement.
Results: Total of 40 ONSD measurements were done in 12 neurosurgical patients. Age of patients ranged from 17-75 years with mean age of 47.33 ± 17.67 years with male to female ratio of 1:2 respectively. Pearson’s correlation coefficient of ONSD and invasive ICP was 0.86 (p-value <0.001) showing significant correlation. Receiver operator characteristic curve generated an area under the curve with value of 0.93 (95% of confidence interval = 0.86 to 1.00). The ONSD cut off value of >5 mm predicted ICP >20 mmHg with a sensitivity of 92.3% and specificity of 85.2%.
Conclusion: There exists a significant correlation between ONSD and invasive ICP with optimal cut off >5 mm to detect raised ICP.
Downloads
References
Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure monitoring technology. J Neurotrauma. 2007;24(1):45–54. PMID: 17511545.
Andrews PJ, Citerio G, Longhi L, Polderman K, Sahuquillo J, Vajkoczy P et al. NICEM consensus on neurological monitoring in acute neurological disease. Intensive Care Med. 2008;34(8):1362–70. PMID: 18398598.
Bellner J, Romner B, Reinstrup P. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004;62(1):45–51. https://doi.org/10.1016/j.surneu.2003.12.007
Shimbles S1, Dodd C, Banister K. Clinical comparison of tympanic membrane displacement with invasive intracranial pressure measurements. Physiol Meas. 2005;26(6):1085–92. https://doi.org/10.1088/0967-3334/26/6/017
Atsumi H. Matsumae M1, Hirayama a, Kuroda K. Measurements of intracranial pressure and compliance index using 1.5-T clinical MRI machine. Tokai J Exp Clin Med. 2014;39(1):34–43. PMID: 24733596
Hiler M1, Czosnyka M, Hutchinson P. Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg. 2006;104(5):731–37. https://doi.org/10.3171/jns.2006.104.5.731
Frumin E, Schlang J, Wiechmann W. Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure. West J Emerg Med. 2014;15(2):217–20. https://dx.doi.org/10.5811%2Fwestjem.2013.9.16191
Dubourg J, Javouhey E, Geeraerts T. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37(7):1059–68. https://doi.org/10.1007/s00134-011-2224-2
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81. PMID: 23234472.
Mattei TA. Intracranial pressure monitoring in severe traumatic brain injury: who is still bold enough to keep sinning against the level I evidence? World Neurosurg. 2013;79(56):602–4. PMID: 23531728.
Hartl R, Stieg PE. Intracranial pressure is still number 1 despite BEST:TRIP study. World Neurosurg. 2013;79(5–6):599–600. PMID: 23528795.
Hawthorne C, Piper I. Monitoring of intracranial pressure in patients with traumatic brain injury. Front Neurol. 2014;5:121. https://doi.org/10.3389/fneur.2014.00121
Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993;116(5):548–56. https://doi.org/10.1016/S0002-9394(14)73195-2
Hansen HC, Helmke K, Kunze K. Optic nerve sheath enlargement in acute intracranial hypertension. Neuroophthalmology. 1994;14:345–54. https://doi.org/10.3109/01658109409024061
Kimberly HH, Noble VE. Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care. 2008;12(5):181. https://doi.org/10.1186/cc7008
Sekhon MS, Griesdale DE, Robba C. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014;40(9):1267–74. https://doi.org/10.1007/s00134-014-3392-7
Bäuerle J, Schuchardt F, Schroeder L. Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol. 2013;13:187. https://doi.org/10.1186/1471-2377-13-187
Kalantari H1, Jaiswal R, Bruck I. Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med. 2013;31(11):1595–97. https://doi.org/10.1016/j.ajem.2013.07.028
Ko S-B. Multimodality Monitoring in the Neurointensive CareUnit: A Special Perspective for Patients with Stroke. Journal of Stroke. 2013;15(2):10. https://dx.doi.org/10.5853%2Fjos.2013.15.2.99
Vender J W J, Dhandapani K, McDonnell D. An evaluation and comparison of intraventricular, intrapar- enchymal, and fluid-coupled techniques for intracranial pressure monitoring in patients with severe trau- matic brain injury. J Clin Monit Comput. 2011;25(4):6. https://doi.org/10.1007/s10877-011-9300-6
Geeraerts T, Launey Y, Martin L. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33:1704-11. https://doi.org/10.1007/s00134-007-0797-6
Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabanis A et al. Optic nerve sonography in the diagnosis evaluation of adult brain injury. Crit Care. 2008;12:R67. https://doi.org/10.1186/cc6897
Shrestha B, Shrestha P, Ghale P, Lakshmipathy G. Correlation between Invasive Intracranial Pressure Monitoring and Optic Nerve Sheath Diameter in Patients with Traumatic Brain Injury. Kathmandu Univ Med J. 2021;74(2):221-4. PMID: 34819440
Maissan IM, Dirven PJ, Haitsma IK, Hoeks SE, Gommers D, Stolker RJ et al. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. Journal of neurosurgery. 2015 Sep;123(3):743-7. https://doi.org/10.3171/2014.10.JNS141197
Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Academic Emergency Medicine. 2008 Feb;15(2):201-4. https://doi.org/10.1111/j.1553-2712.2007.00031.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright © Journal of Kathmandu Medical College
The ideas and opinions expressed by authors or articles summarized, quoted, or published in full text in this journal represent only the opinions of the authors and do not necessarily reflect the official policy of Journal of Kathmandu Medical College or the institute with which the author(s) is/are affiliated, unless so specified.
Authors convey all copyright ownership, including any and all rights incidental thereto, exclusively to JKMC, in the event that such work is published by JKMC. JKMC shall own the work, including 1) copyright; 2) the right to grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right to republish the work in a collection of articles in any other mechanical or electronic format.
