Optic nerve sheath diameter ultrasonography

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Optic nerve sheath diameter ultrasonography

Optic nerve sheath diameter ultrasonography is strongly correlated with invasive ICPmeasurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after decompressive craniectomy 1).

Optic nerve sheath diameter measured by transorbital ultrasound imaging is an accurate method for detecting intracranial hypertension that can be applied in a broad range of settings. It has the advantages of being a non-invasive, bedside test, which can be repeated multiple times for re-evaluation 2).

Evolution of ultrasound technology and the development of high frequency (> 7.5 MHz) linear probes with improved spatial resolution have enabled excellent views of the optic nerve sheath.

The optic nerve sheath diameter (ONSD), measured at a fixed distance behind the retina has been evaluated to diagnose and measure intracranial hypertension in traumatic brain injury and intracranial hemorrhage 3) 4).

The optic nerve sheath is fairly easy to visualize by ultrasonography by insonation across the orbit in the axial plane. A-mode ultrasonography was used to view the optic nerve sheath more than four decades ago; B-mode scanning was performed subsequently to assess intraocular lesions 5).

Shirodkar et al., studied the efficacy of ONSD measurement by ultrasonography to predict intracranial hypertension. The case mix studied included meningoencephalitis, stroke, intracranial hemorrhage and metabolic encephalopathy. Using cut-off values of 4.6 mm for females, and 4.8 mm for males, they found a high level of sensitivity and specificity for the diagnosis of intracranial hypertension as evident on CT or MRI imaging 6).

There is wide variation reported in the optimal cut-off values, when ONSD was compared with invasive ICP monitoring, ranging from 4.8 to 5.9 mm7) 8).

Padayachy et al present a method for assessment of optic nerve sheath ONS pulsatile dynamics using transorbital ultrasound imaging. A significant difference was noted between the patient groups, indicating that deformability of the ONS may be relevant as a noninvasive marker of raised ICP 9).

Of the studied ultrasound noninvasive intracranial pressure monitoring, optic nerve sheath diameter (ONSD), is the best estimator of ICP. The novel combination of optic nerve sheath diameter ultrasonography and venous transcranial Doppler (vTCD) of the straight sinus is a promising and easily available technique for identifying critically ill patients with intracranial hypertension 10).

The optic nerve sheath diameter has been verified by various clinical studies as a non-invasive indicator of intracranial hypertension 11).

Correlations between ICP and Optic nerve sheath diameter (ONSD) using CT and MRI have been observed in adult populations.

Ultrasound methods has been proposed as an alternative safe technique for invasive ICP measuring methods 12).

Admission ONSD in decompressive craniectomy (DC) patients is high but does not predict mortality and unfavorable outcomes 13).

Intracranial pressure (ICP) can be noninvasively estimated from the sonographic measurement of the optic nerve sheath diameter (ONSD) and from the transcranial Doppler analysis of the pulsatility (ICPPI) and the diastolic component (ICPFVd) of the velocity waveform 14).

Where pediatric patients present with an ONSD of over 6.1mm following a TBI, ICP monitoring should be implemented 15).

Padayachy et al present a method for assessment of ONS pulsatile dynamics using transorbital ultrasound imaging. A significant difference was noted between the patient groups, indicating that deformability of the ONS may be relevant as a noninvasive marker of raised ICP 16).

While the ultrasonographic mean binocular ONSD (>4.53 mm) was completely accurate in detecting elevated ICP, color Doppler indices of the ophthalmic arteries were of limited value 17).

Bedside ultrasound may be useful in the diagnosis of midline intracranial shift by measurement of ONSD 18).

In patients with SAH and acute hydrocephalus after aneurysm rupture, the ONSD remains expanded after normalization of ICP. This is most likely due to an impaired retraction capability of the optic nerve sheath. This finding should be considered when using transorbital sonography in the neuromonitoring of aneurysmal SAH 19).

ONSD >5.5 mm yielded a sensitivity of 98.77% (95% CI: 93.3%-100%) and a specificity of 85.19% (95% CI: 66.3%-95.8%).In conclusion, the optimal cut-off point of ONSD for identifying IICP was 5.5 mm. ONSD seen on ocular US can be a feasible method for detection and serial monitoring of ICP in Korean adult patients 20).

Systematic review

The aim of a systematic review and meta-analysis will be to examine the accuracy of ONSD sonography for increased ICP diagnosis.

Koziarz et al. will include published and unpublished randomised controlled trials, observational studies, and abstracts, with no publication type or language restrictions. Search strategies will be designed to peruse the MEDLINE, Embase, Web of Science, WHO Clinical Trials, ClinicalTrials.gov, CINAHL, and the Cochrane Library databases. We will also implement strategies to search grey literature. Two reviewers will independently complete data abstraction and conduct quality assessment. Included studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We will construct the hierarchical summary receiver operating characteristic curve for included studies and pool sensitivity and specificity using the bivariate model. We also plan to conduct prespecified subgroup analyses to explore heterogeneity. The overall quality of evidence will be rated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Research ethics board approval is not required for this study as it draws from published data and raises no concerns related to patient privacy. This review will provide a comprehensive assessment of the evidence on ONSD sonography diagnostic accuracy and is directed to a wide audience. Results from the review will be disseminated extensively through conferences and submitted to a peer-reviewed journal for publication 21).

Case series

Optic nerve sheath diameter ultrasonography case series.

References

1)

Wang J, Li K, Li H, Ji C, Wu Z, Chen H, Chen B. Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg. 2019 Jul 19:1-7. doi: 10.3171/2019.4.JNS183297. [Epub ahead of print] PubMed PMID: 31323632.
2)

Beare NA, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, Molyneux ME. Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health. 2008 Nov;13(11):1400-4. doi: 10.1111/j.1365-3156.2008.02153.x. Epub 2008 Oct 13. PubMed PMID: 18983275; PubMed Central PMCID: PMC3776606.
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Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008;34:2062–7.
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Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: Confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol. 2009;21:16–20.
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Gangemi M, Cennamo G, Maiuri F, D’Andrea F. Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987;30:53–5.
6)

Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study. Ind J Crit Care Med. 2014;18:728–734
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Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care. 2011;15:506–15.
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Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. 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.
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Padayachy L, Brekken R, Fieggen G, Selbekk T. Pulsatile Dynamics of the Optic Nerve Sheath and Intracranial Pressure: An Exploratory In Vivo Investigation. Neurosurgery. 2016 Jul;79(1):100-7. doi: 10.1227/NEU.0000000000001200. PubMed PMID: 26813857; PubMed Central PMCID: PMC4900421.
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Robba C, Cardim D, Tajsic T, Pietersen J, Bulman M, Donnelly J, Lavinio A, Gupta A, Menon DK, Hutchinson PJA, Czosnyka M. Ultrasound non-invasive measurement of intracranial pressure in neurointensive care: A prospective observational study. PLoS Med. 2017 Jul 25;14(7):e1002356. doi: 10.1371/journal.pmed.1002356. eCollection 2017 Jul. PubMed PMID: 28742869.
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Choi SH, Min KT, Park EK, Kim MS, Jung JH, Kim H. Ultrasonography of the optic nerve sheath to assess intracranial pressure changes after ventriculo-peritoneal shunt surgery in children with hydrocephalus: a prospective observational study. Anaesthesia. 2015 Nov;70(11):1268-73. doi: 10.1111/anae.13180. Epub 2015 Aug 24. PubMed PMID: 26299256.
12)

Karami M, Shirazinejad S, Shaygannejad V, Shirazinejad Z. Transocular Doppler and optic nerve sheath diameter monitoring to detect intracranial hypertension. Adv Biomed Res. 2015 Oct 22;4:231. doi: 10.4103/2277-9175.167900. eCollection 2015. PubMed PMID: 26645016; PubMed Central PMCID: PMC4647120.
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Waqas M, Bakhshi SK, Shamim MS, Anwar S. Radiological prognostication in patients with head trauma requiring decompressive craniectomy: Analysis of optic nerve sheath diameter and Rotterdam CT Scoring System. J Neuroradiol. 2016 Feb;43(1):25-30. doi: 10.1016/j.neurad.2015.07.003. Epub 2015 Oct 20. PubMed PMID: 26492980.
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Robba C, Bragazzi NL, Bertuccio A, Cardim D, Donnelly J, Sekhon M, Lavinio A, Duane D, Burnstein R, Matta B, Bacigaluppi S, Lattuada M, Czosnyka M. Effects of Prone Position and Positive End-Expiratory Pressure on Noninvasive Estimators of ICP: A Pilot Study. J Neurosurg Anesthesiol. 2016 Mar 18. [Epub ahead of print] PubMed PMID: 26998650.
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Young AM, Guilfoyle MR, Donnelly J, Scoffings D, Fernandes H, Garnett MR, Agrawal S, Hutchinson PJ. Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury. Pediatr Res. 2016 Aug 11. doi: 10.1038/pr.2016.165. [Epub ahead of print] PubMed PMID: 27513519.
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Tarzamni MK, Derakhshan B, Meshkini A, Merat H, Fouladi DF, Mostafazadeh S, Rezakhah A. The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure. Clin Neurol Neurosurg. 2016 Feb;141:82-8. doi: 10.1016/j.clineuro.2015.12.007. Epub 2015 Dec 15. PubMed PMID: 26771156.
18)

Kazdal H, Kanat A, Findik H, Sen A, Ozdemir B, Batcik OE, Yavasi O, Inecikli MF. Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Intracranial Midline Shift in Patients with Head Trauma. World Neurosurg. 2016 Jan;85:292-7. doi: 10.1016/j.wneu.2015.10.015. Epub 2015 Oct 17. PubMed PMID: 26485420.
19)

Bäuerle J, Niesen WD, Egger K, Buttler KJ, Reinhard M. Enlarged Optic Nerve Sheath in Aneurysmal Subarachnoid Hemorrhage despite Normal Intracranial Pressure. J Neuroimaging. 2016 Mar-Apr;26(2):194-6. doi: 10.1111/jon.12287. Epub 2015 Aug 17. PubMed PMID: 26278326.
20)

Lee SU, Jeon JP, Lee H, Han JH, Seo M, Byoun HS, Cho WS, Ryu HG, Kang HS, Kim JE, Kim HC, Jang KS. Optic nerve sheath diameter threshold by ocular ultrasonography for detection of increased intracranial pressure in Korean adult patients with brain lesions. Medicine (Baltimore). 2016 Oct;95(41):e5061. PubMed PMID: 27741121; PubMed Central PMCID: PMC5072948.
21)

Koziarz A, Sne N, Kegel F, Alhazzani W, Nath S, Badhiwala JH, Rice T, Engels P, Samir F, Healey A, Kahnamoui K, Banfield L, Sharma S, Reddy K, Hawryluk GWJ, Kirkpatrick AW, Almenawer SA. Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol. BMJ Open. 2017 Aug 11;7(8):e016194. doi: 10.1136/bmjopen-2017-016194. PubMed PMID: 28801417.

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