Evaluation of Increased Intracranial Pressure with the Optic Nerve Sheath Diameter by Ultrasound in Epiduroscopic Neural Laser Discectomy Procedures

Optic Nerve Sheath ◽

Fluid Delivery ◽

Nerve Sheath ◽

Randomized Controlled Studies ◽

Significant Difference

BACKGROUND: In order to clarify the camera image and open the adhesions mechanically during epiduroscopy, saline is injected continuously in the epidural area. As a result, an increase in intracranial pressure is to be expected in theory. Increased intracranial pressure can be evaluated by measuring by optic nerve sheath diameter. OBJECTIVES: This study was designed to evaluate the relationship between optic nerve sheath diameter measurements and intracranial pressure, after injecting fluid to the epidural area during epiduroscopy procedures performed in our clinic. STUDY DESIGN: Retrospective study. SETTING: Sakarya University Training and Research Hospital. METHODS: During the epiduroscopy procedure, pre and postoperative bilateral optic nerve sheath diameters were measured with an ultrasonography probe. With the patients’ eyelids closed, the probe was placed on the orbita in the sagittal plane, measuring 3 mm posterior of the papilla. RESULTS: While there was a statistically significant difference between pre- and post-operative optic nerve sheath diameter measurements, there was no significant correlation with processing time, amount of fluid delivered, or fluid delivery rates. LIMITATIONS: One of the limitations of this study is the retrospective collection of data. A second limitation is that repetitive measurements were not performed, instead of a single postoperative measurement. CONCLUSION: We think more prospective randomized controlled studies are required to examine the increase in the diameter of the optic nerve sheath, which is an indirect indicator of increased intracranial pressure after epiduroscopy applications, in order to determine whether the pressure increase is associated with the rate of fluid delivery, the total fluid amount, or the processing time. KEY WORDS: Epidural, epiduroscopic laser neural decompression, fluid volume, intracranial pressure, optic nerve sheath diameter, ultrasonography, rate

Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: a meta-analysis

Acta Radiologica ◽

10.1177/0284185118776501 ◽

2018 ◽

Vol 60 (2) ◽

pp. 221-229 ◽

Cited By ~ 10

Author(s):

Sung-Eun Kim ◽

Eun Pyo Hong ◽

Heung Cheol Kim ◽

Si Un Lee ◽

Jin Pyeong Jeon

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Meta Analysis ◽

Optic Nerve Sheath ◽

Summary Receiver Operating Characteristic ◽

Nerve Sheath ◽

Study Characteristics ◽

Meta Regression

Background The optimal optic nerve sheath diameter (ONSD) cut-off for identifying increased intracranial pressure (IICP) remains unclear in adult patients. Purpose To validate the diagnostic accuracy of ultrasonographic (US) ONSD > 5.0 mm as a cut-off for detecting IICP by computed tomographic (CT) through a meta-analysis. Material and Methods A systemic literature review was performed of online databases from January 1990 to September 2017. A bivariate random-effects model was used to estimate pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs). A summary receiver operating characteristic (SROC) graph was used to provide summary points for sensitivity and specificity. Meta-regression tests were performed to estimate the influence of the study characteristics on DOR. Publication bias was assessed using Deeks' funnel plot asymmetry test. Results Six studies with 352 patients were included in the meta-analysis. US ONSD > 5.0 mm revealed pooled sensitivity of 99% (95% CI = 96–100) and specificity of 73% (95% CI = 65–80) for IICP detection. DOR was 178. The area under the SROC curve was 0.981, indicating a good level of accuracy. Meta-regression studies showed no significant associations between DOR and study characteristics such as probe mode (relative DOR [RDOR] = 0.60; P = 0.78), study quality (RDOR = 0.52; P = 0.67), IICP prevalence (RDOR = 0.04; P = 0.17), or pathology at admission (RDOR = 1.30; P = 0.87). Conclusion US ONSD > 5.0 mm can be used to rapidly detect IICP in adults in emergency departments and intensive care units. Further meta-analysis based on individual patient-level databases is needed to confirm these results.

Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(09)79501-7 ◽

2010 ◽

Vol 2010 ◽

pp. 319-320

Author(s):

R.J. Shephard

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Acute Mountain Sickness ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Mountain Sickness

Optic Nerve Sheath Diameter Ultrasound and the Diagnosis of Increased Intracranial Pressure

Critical Care Nursing Clinics of North America ◽

10.1016/j.cnc.2015.10.005 ◽

2016 ◽

Vol 28 (1) ◽

pp. 95-99 ◽

Cited By ~ 7

Author(s):

Christopher Hylkema

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Sheath ◽

Nerve Sheath

Accuracy of Noninvasive Intraocular Pressure or Optic Nerve Sheath Diameter Measurements for Predicting Elevated Intracranial Pressure in Cryptococcal Meningitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu093 ◽

2014 ◽

Vol 1 (3) ◽

Cited By ~ 20

Author(s):

Henry W. Nabeta ◽

Nathan C. Bahr ◽

Joshua Rhein ◽

Nicholas Fossland ◽

Agnes N. Kiragga ◽

...

Keyword(s):

Intraocular Pressure ◽

Optic Nerve ◽

Intracranial Pressure ◽

Cryptococcal Meningitis ◽

Diagnostic Value ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Immunodeficiency Virus

Abstract Background. Cryptococcal meningitis is associated with increased intracranial pressure (ICP). Therapeutic lumbar puncture (LP) is recommended when the initial ICP is >250 mm H2O, yet the availability of manometers in Africa is limited and not always used where available. We assessed whether intraocular pressure could be a noninvasive surrogate predictor to determine when additional therapeutic LPs are necessary. Methods. Ninety-eight human immunodeficiency virus-infected Ugandans with suspected meningitis (81% Cryptococcus) had intraocular pressure measured using a handheld tonometer (n = 78) or optic nerve sheath diameter (ONSD) measured by ultrasound (n = 81). We determined the diagnostic performance of these methods for predicting ICP vs a standard manometer. Results. The median ICP was 225 mm H2O (interquartile range [IQR], 135–405 mm H2O). The median intraocular pressure was 28 mm Hg (IQR, 22–37 mm Hg), and median ultrasound ONSD was 5.4 mm (IQR, 4.95–6.1 mm). ICP moderately correlated with intraocular pressure (ρ = 0.45, P < .001) and with ultrasound ONSD (ρ = 0.44, P < .001). There were not discrete threshold cutoff values for either tonometry or ultrasound ONSD that provided a suitable cutoff diagnostic value to predict elevated ICP (>200 mm H2O). However, risk of elevated ICP >200 mm H2O was increased with an average intraocular pressure >28 mm Hg (relative risk [RR] = 3.03; 95% confidence interval [CI], 1.55–5.92; P < .001) or an average of ONSD >5 mm (RR = 2.39; 95% CI, 1.42–4.03; P = .003). As either intraocular pressure or ONSD increased, probability of elevated ICP increased (ie, positive predictive value increased). Conclusions. Noninvasive intraocular pressure measurements by tonometry or ultrasound correlate with cerebrospinal fluid opening pressure, but both are a suboptimal replacement for actual ICP measurement with a manometer.