Figure - available from: Therapeutic Advances in Neurological Disorders
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Scatterplot between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP). X-axis represents ONSD, Y-axis ICP.
Source publication
Background
Invasive intracranial pressure (ICP) can result in complications, pain, or even aggravate intracranial hypotension (IH) or headache in patients with IH.
Objective
To investigate whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) could serve as a noninvasive IH marker.
Methods
Ultrasonographic ONSD was measured...
Citations
... In humans, a noninvasive estimation of the intracranial pressure and the detection of increased intracranial pressure can be achieved with the help of ultrasound-guided measurement of the optic nerve sheath diameter (ONSD). A non-invasive method to estimate changes in the ICP in humans is to measure the optical nerve sheath diameter (ONSD) using ultrasound [9][10][11]. Several studies on patients undergoing RALP have shown that the ONSD can increase significantly [12][13][14]. ...
In addition to general anesthesia and mechanical ventilation, robotic-assisted laparoscopic radical prostatectomy (RALP) necessitates maintaining a capnoperitoneum and placing the patient in a pronounced downward tilt (Trendelenburg position). While the effects of the resulting fluid shift on the cardiovascular system seem to be modest and well tolerated, the effects on the brain and the blood–brain barrier have not been thoroughly investigated. Previous studies indicated that select patients showed an increase in the optic nerve sheath diameter (ONSD), detected by ultrasound during RALP, which suggests an elevation in intracranial pressure. We hypothesize that the intraoperative fluid shift results in endothelial dysfunction and reduced cerebral clearance, potentially leading to transient neuronal damage. This prospective, monocentric, non-randomized, controlled clinical trial will compare RALP to conventional open radical prostatectomy (control group) in a total of 50 subjects. The primary endpoint will be the perioperative concentration of neurofilament light chain (NfL) in blood using single-molecule array (SiMoA) as a measure for neuronal damage. As secondary endpoints, various other markers for endothelial function, inflammation, and neuronal damage as well as the ONSD will be assessed. Perioperative stress will be evaluated by questionnaires and stress hormone levels in saliva samples. Furthermore, the subjects will participate in functional tests to evaluate neurocognitive function. Each subject will be followed up until discharge. Conclusion: This trial aims to expand current knowledge as well as to develop strategies for improved monitoring and higher safety of patients undergoing RALP. The trial was registered with the German Clinical Trials Register DRKS00031041 on 11 January 2023.
... The optic nerve is a structure of the central nervous system surrounded by the dural sheath and has direct anatomical relationship with the intracranial subarachnoid space [11]. In recent years, many studies have examined the correlation of the optic nerve sheath diameter (ONSD) with ICP and conditions causing it [12][13][14][15][16][17][18]. In addition, although there are a few studies in the literature demonstrating the relationship between ONSD and hyponatremia, there is no study examining the relationship between ONSD and hypernatremia [11,19]. ...
Aim:
This study aimed to investigate the diagnostic and prognostic value of optic nerve sheath diameter (ONSD) measurement in patients with dysnatremia.
Material and methods:
This prospective clinical study included patients aged ≥18 years who were diagnosed with dysnatremia on admission to the emergency department.
Results:
The present study included 65 patients (35 with hypernatremia [hypernatremia group] and 30 with hyponatremia [hyponatremia group]) and 14 healthy volunteers (control group). Comparison of these groups in terms of ONSD revealed that the right and left ONSDs were significantly higher in the hypernatremia and hyponatremia groups comparing to the control group (p<0.001). According to the optimal cutoff values determined, the right ONSD detected hypernatremia with 91.4% sensitivity and 92.9% specificity and the left ONSD detected the condition with 88.6% sensitivity and 85.7% specificity. Furthermore, the right ONSD detected hyponatremia with 83.3% sensitivity and 92.9% specificity, and the left ONSD detected it with 93.0% sensitivity and 86.0% specificity. Finally, ONSD was found to be an independent predictor of mortality in patients with hypernatremia.
Conclusion:
ONSD is a noninvasive, easy, cheap, and reproducible measurement and can be used as an effective and powerful tool for the diagnosis of patients with dysnatremia and the prognosis of patients with hypernatremia.
... Therefore, timely and effective monitoring of ICP is essential for the treatment and condition monitoring of patients who have headache due to intracranial lesions. Invasive ICP monitoring is the gold standard for the diagnosis of high ICP, but this is accompanied with complications such as bleeding and infection [2]. Additionally, some patients require repeated measurements throughout the treatment, which causes additional pain. ...
Background
Patients with encephalitis and high intracranial pressure (ICP) may have increased optic disc height (ODH) and widened optic nerve sheath diameter (ONSD). This study investigated whether ONSD and ODH under ultrasound can dynamically evaluate the change of high ICP in encephalitis patients.
Methods
We recruited suspected high ICP patients who underwent lumbar puncture. The ODH and ONSD was measured before the lumbar puncture. ODH, ONSD and ICP were recorded at admission, two weeks followed up and one month followed up. We analyzed the correlation between ODH, ONSD, and ICP and its changes. The predicted fit was also compared by linear mixed-effects models.
Results
Totally, 56 headache patients with high ICP were enrolled. On admission, the correlation between ODH and ICP had an r value of 0.586 (P < 0.01), and between ONSD and ICP, an r value of 0.769 (P < 0.01). Two weeks followed up, no significant correlation between ODH change and ICP change (P = 0.536). But the change in ONSD was associated with changes in ICP (r = 0.572, P < 0.001). One month followed up, the correlation between ONSD change and ICP change were stronger than those between ODH change and ICP change (r = 0.667 vs. r = 0.435, P < 0.01). In linear mixed-effects model, ONSD had a better fitting value than ODH in the prediction model for ICP (P < 0.05).
Conclusions
Noninvasive ultrasonic ODH and ONSD are useful in assessing the presence of high ICP in encephalitis patients. ONSD is an earlier and more sensitive indicator for dynamically and noninvasively assessing the elevated ICP than ODH.
... Compared to invasive ICP measurements (intraventricular, intraparenchymal, subdural, epidural, and lumbar catheterization techniques), ultrasonography (USG)-guided optic nerve sheath diameter (ONSD) measurement is a noninvasive, reliable, and inexpensive technique that simultaneously reflects changes in ICP. Studies have shown a correlation between ICP monitoring and ONSD [4,7]. ...
Purpose
Intracranial hypotension due to cerebrospinal fluid leak is mainly the causal factor for the pathophysiology of postdural puncture headache (PDPH). In this study, we aimed to evaluate the effectiveness of optic nerve sheath diameter (ONSD) measurement in predicting the development of PDPH in patients undergoing spinal anesthesia.
Methods
According to the American Society of Anesthesiology (ASA) physical classification I–III, 83 patients aged 18–65 years scheduled for spinal anesthesia for elective surgery were included in the study. Demographic data (age, ASA, sex, smoking, migraine, and PDPH history) and operative data were recorded. Preoperative ONSD measurements were taken in the right and left eye, axial, and sagittal planes. The mean of four measurements was recorded before and 24 h after the spinal anesthesia.
Results
A total of 83 patients (59 males and 24 females) were included in the study. In our study, the rate of PDPH development was determined as 22.9% (n = 19). There was a statistically significant difference in the preoperative and postoperative ONSD values between patients with and without PDPH development (p = 0.046). In the receiver operating characteristic analysis, the area under the curve was 0.843, and the cutoff value was 0.4.
Conclusion
The difference between the ONSD values measured before and after spinal anesthesia may be an important parameter for predicting the risk of PDPH development.
... According to the previous studies, mean values of ONSD in patients with intracranial hypotension were from 2.96 +/-0.15 mm [22] to 3.2 +/-0.3 mm [23]. ...
Transorbital sonography is a reliable method for non-invasive assessment of optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) in patients with increased intracranial pressure. A wide range of regular ONSD values has been reported in the literature. The aim of this study was to determine normal values for OND and ONSD, to determine differences between OND and ONSD considering sex, age, and body mass index (BMI), and to evaluate inter - and intra - examiner variability. The study included 100 healthy subjects, aged 22 - 87 years, who underwent transbulbar sonography by the two examiners, each examiner measuring OND and ONSD twice on both eyes at a depth of 3 mm behind the optic nerve papilla. Measurement and analysis of OND and ONSD was possible in all subjects. Mean OND was 2.39 +/- 0.28 mm and mean ONSD was 4.48 +/- 0.76 mm. In males, mean OND was 2.47 +/- 0.28 mm and in females 2.35 +/- 0.27 mm (p = 0.042). There was no statistically significant difference between mean ONSD values between sexes (p > 0.001). Correlation between age and mean OND and ONSD wasn`t observed. Positive correlation between mean OND and BMI (p = 0.001) was observed. Positive correlation within and between investigator measurements (p < 0.01) was shown. Men have a wider OND compared to women, but no difference in ONSD was observed. Age doesn`t effect on the width of OND and ONSD. BMI correlates positively with OND, but not with ONSD. Positive correlation within and between investigator measurements was shown.
... 16 Wang et al. described optic nerve sheath diameter (ONSD) as another potential noninvasive predictor of ICHTN, reporting a significant linear correlation between ONSD and ICP. [17][18][19] In children, one study suggested that radiological information on CTH, including both the Marshall score and the RS, do not add any diagnostic utility to the prediction of ICHTN. 20 Although several studies have suggested that noninvasive or radiographic methods can screen patients for ICHTN, invasive methods provide the advantage of being able to titrate therapies on a continuous basis. ...
Objective:
Severe traumatic brain injury (TBI) is associated with intracranial hypertension (ICHTN). The Rotterdam CT score (RS) can predict clinical outcomes following TBI, but the relationship between the RS and ICHTN is unknown. The purpose of this study was to investigate clinical and radiological factors that predict ICHTN in patients with severe TBI.
Methods:
The authors performed a single-center retrospective review of patients who, between 2018 and 2021, had an intracranial pressure (ICP) monitor placed following TBI. Radiological and clinical characteristics related to the TBI and ICP monitoring were collected. The main outcome of interest was ICHTN, which was a dichotomous outcome (yes or no) defined on a per-patient basis as an ICP > 22 mm Hg that persisted for at least 5 minutes and required an escalation of treatment. ICHTN included both elevated opening pressure on initial monitor placement and ICP elevations later during hospitalization. Multivariate logistic regression was performed to determine variables associated with ICHTN. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC).
Results:
Seventy patients with severe TBI and an ICP monitor were included in this study. There was a predominance of male patients (94.0%), and the mean patient age was 40 years old. Most patients (67%) had an intraparenchymal catheter placed, whereas 33% of patients had a ventriculostomy catheter placed. In the multivariate logistic regression analysis, the RS was an independent predictor of ICHTN (OR 2.0, 95% CI 1.2-3.5, p = 0.014). No instances of ICHTN were observed in patients with an RS of 2 or less and no sulcal effacement. The AUROC of the RS and sulcal effacement was higher than the AUROC of the RS alone for predicting ICHTN (0.76 vs 0.71, p = 0.003, z-test).
Conclusions:
The RS was predictive of ICHTN in patients with severe TBI, and the diagnostic accuracy of the model was improved with the inclusion of sulcal effacement at the vertex on CT of the head. Patients with a low RS and no sulcal effacement are likely at low risk for the development of ICHTN.
Background and purpose:
Spontaneous spinal CSF leaks typically cause orthostatic headache, but their detection may require specialized and invasive spinal imaging. We undertook a study to determine the value of simple optic nerve sheath MR imaging measurements in predicting the likelihood of finding a CSF-venous fistula, a type of leak that cannot be detected with routine spine MR imaging or CT myelography, among patients with orthostatic headache and normal conventional brain and spine imaging findings.
Materials and methods:
This cohort study included a consecutive group of patients with orthostatic headache and normal conventional brain and spine imaging findings who underwent digital subtraction myelography under general anesthesia to look for spinal CSF-venous fistulas.
Results:
The study group consisted of 93 patients (71 women and 22 men; mean age, 47.5 years; range, 17-84 years). Digital subtraction myelography demonstrated a CSF-venous fistula in 15 patients. The mean age of these 8 women and 7 men was 56 years (range, 23-83 years). The mean optic nerve sheath diameter was 4.0 mm, and the mean perioptic subarachnoid space was 0.5 mm in patients with a CSF-venous fistula compared with 4.9 and 1.2 mm, respectively, in patients without a fistula (P < .001). Optimal cutoff values were found at 4.4 mm for optic nerve sheath diameter and 1.0 mm for the perioptic subarachnoid space. Fistulas were detected in about 50% of patients with optic nerve sheath diameter or perioptic subarachnoid space measurements below these cutoff values compared with <2% of patients with optic nerve sheath diameter or perioptic subarachnoid space measurements above these cutoff values. Following surgical ligation of the fistula, optic nerve sheath diameter increased from 4.0 to 5.3 mm and the perioptic subarachnoid space increased from 0.5 to 1.2 mm (P < .001).
Conclusions:
Concerns about a spinal CSF leak should not be dismissed in patients with orthostatic headache when conventional imaging findings are normal, and simple optic nerve sheath MR imaging measurements can help decide if more imaging needs to be performed in this patient population.
Objective
The purpose of this study was to evaluate the prevalence of idiopathic intracranial hypertension (IIH) in fibromyalgia (FMS) patients by utilizing ultrasound to measure the optic nerve sheath diameter (ONSD), a marker of elevated intracranial pressure and also to investigate the relationship with function, fatigue, quality of life (QOL), central sensitization (CS) and neuropathic pain.
Methods
The study encompassed 80 female FMS patients and 75 healthy controls. Ultrasound was employed to measure the average ONSD in both groups. Conditions potentially elevating intracranial pressure were ruled out following neurological assessments. Pain (via visual analog scale, VAS), function (revised Fibromyalgia Impact Questionnaire, r‐FIQ), QOL (Short Form‐36, SF‐36), fatigue (fatigue severity scale, FACIT), CS (Central Sensitization Scale), and neuropathic pain (Douleur Neuropathique‐4) were evaluated.
Results
The average ONSD was significantly higher in the patient group than the control group. Patients with ONSD >5.5 mm consistent with IIH were categorized as Group 1 ( n = 54, 67.5%), while those with a diameter of 5.5 mm and below‐formed Group 2. VAS pain ( p = .033) and FIQ‐R scores ( p = .033) were significantly higher in Group 1 than Group 2. Headache was found more common in Group 1.
Conclusion
This study unveils a substantial occurrence (67.5%) of IIH in FMS patients, suggesting shared pathophysiological mechanisms contributing to symptoms like fatigue, headache, and cognitive dysfunction. Additionally, these findings implicate heightened functional impairment, CS, headache, and fatigue in FMS patients with IIH.
Purpose of review:
Intracranial pressure (ICP) is determined by the production of and outflow facility of cerebrospinal fluid. Since alterations in ICP are implicated in several vision-threatening and life-threatening diseases, measurement of ICP is necessary and common. All current clinical methods to measure ICP are invasive and carry the risk for significant side effects. Therefore, the development of accurate, reliable, objective, and portal noninvasive devices to measure ICP has the potential to change the practice of medicine. This review discusses recent advances and barriers to the clinical implementation of noninvasive devices to determine ICP.
Recent findings:
Many noninvasive methods to determine ICP have been developed. Although most have significant limitations limiting their clinical utility, several noninvasive methods have shown strong correlations with invasively obtained ICP and have excellent potential to be developed further to accurately quantify ICP and ICP changes.
Summary:
Although invasive methods remain the mainstay for ICP determination and monitoring, several noninvasive biomarkers have shown promise to quantitatively assess and monitor ICP. With further refinement and advancement of these techniques, it is highly possible that noninvasive methods will become more commonplace and may complement or even supplant invasively obtained methods to determine ICP in certain situations.
