Left Optic Nerve Sheath Diameter Research Articles

Diagnostic and prognostic efficacy of optic nerve sheath diameter in patients with dysnatremia.

This study aimed to investigate the diagnostic and prognostic value of optic nerve sheath diameter (ONSD) measurement in patients with dysnatremia. This prospective clinical study included patients aged ≥18 years who were diagnosed with dysnatremia on admission to the emergency department. 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. 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.

Transcranial ultrasonographic evaluation of effect of ventriculoperitoneal shunt on intracranial dynamics: A prospective observational study

BackgroundTranscranial sonographic (TCS) evaluation of optic nerve sheath diameter (ONSD), third ventricular diameter (TVD) and mean flow velocities (Vm) and pulsatility index (PI) of middle cerebral artery (MCA) can provide important insights to the change in intracranial dynamics following ventriculo-peritoneal (VP) shunt surgery. The primary objective of this study was to observe changes in ONSD values following VP shunt at 12 h, compared to pre-VP shunt values. MethodsAfter obtaining ethical approval, patients admitted with a diagnosis of hydrocephalus posted for a VP shunt surgery were prospectively enrolled. TCS evaluation was done before induction of anesthesia and 12-hour post-VP shunt surgery. We recorded the values of ONSD, TVD and Vm and PI MCA at both time points. ResultsThirty-four patients (19 male) were evaluated for ONSD and for the improvement of symptoms. Transtemporal window could not be obtained in six patients. At 12 h following VP shunt, bilateral median ONSD values reduced significantly from their pre-VP shunt values [right ONSD- 0.62 (0.59–0.64) to 0.53 (0.5–0.54) mm (p < 0.001); left ONSD- 0.62 (0.59–0.63) to 0.53 (0.5–0.54) mm (p < 0.001)]. Similarly, the median TVD at 12 h post-VP shunt reduced significantly from its pre-VP shunt measurements [0.97 (0.85–1.09) to 0.74 (0.7–0.84) cm]. PI MCA values reduced significantly, while Vm MCA values increased significantly from the pre-VP shunt values. ConclusionVP shunt reduced the ONSD, TVD, PI MCA and increased the Vm MCA after shunt surgery as early as 12hrs.

Optic nerve sheath diameter measurements to predict delayed neurological sequelae after carbon monoxide poisoning

Objectives Delayed neurological sequelae are a major complication of carbon monoxide poisoning. However, today there is still no objective screening tool for predicting delayed neurological sequelae in patients with carbon monoxide poisoning. The present study aimed to assess the usefulness of optic nerve sheath diameter measurements in predicting delayed neurological sequelae after carbon monoxide poisoning. Methods In this retrospective study, patients with a diagnosis of carbon monoxide poisoning in the emergency department from 2010 to 2021 were included in the study. Right and left optic nerve sheath diameters were calculated based on cranial computed tomography scans, and the presence of delayed neurological sequelae was evaluated. Results The mean (± standard deviation) optic nerve sheath diameter in patients who developed delayed neurological sequelae was statistically significantly greater on both the right and left compared to patients who did not develop delayed neurological sequelae (right; 5.02 ± 0.06 mm versus 4.89 ± 0.07 mm, P < 0.001; left; 5.03 ± 0.09 mm versus 4.85 ± 0.10 mm, P < 0.001). A multivariate linear regression analysis revealed that carboxyhemoglobin and both right and left optic nerve sheath diameter were the factors associated with the delayed neurological sequelae. Discussion The present study revealed that optic nerve sheath diameter measurements may be a useful screening tool to predict delayed neurological sequelae after carbon monoxide poisoning. The ability to predict a poor neurological prognosis in carbon monoxide poisoning is important for initiating early rehabilitation interventions and make help future trials. Limitations of this study include that normal optic nerve sheath diameters are not well established, and that not every patient underwent computed tomography. Conclusions Optic nerve sheath diameters measurements may be a helpful screening tool for predicting delayed neurological sequelae after carbon monoxide poisoning.

The Effect of Different Optic Nerve Sheath Diameter Measurements Using Ultrasound to Assess Intracranial Pressure in Patients With Acute Brain Injury.

Optic nerve sheath diameter (ONSD) is a promising, noninvasive invasive intracranial pressure (ICP) measurement method. This study aims to analyze the differences in ONSD between the left and right eyeballs and the differences in ultrasonic measurement between the transverse and sagittal planes. Data from a total of 50 eligible patients with various types of brain injury who were admitted to our hospital from May 2019 to June 2021 were analyzed. An ONSD assessment was then performed using Philips B-mode ultrasound, measuring ONSD 3 mm posterior to the eyeballs. The left and right ONSDs in the transverse and sagittal planes were measured. Intraparenchymal fiber optic sensors and catheters were inserted into the ventricles and connected to an external pressure transducer to measure ICP. A total of 164 sonographic measurements of ONSD were performed in 50 patients with brain injury in a prospective observational study. Statistically significant differences were found in ONSD between the transverse and sagittal planes. The difference in the left ONSD between the transverse and sagittal planes was 0.007 ± 0.030 cm (P = 0.003). The Spearman rank correlation test showed that the correlation coefficient between ICP and left/right ONSD in the transverse/sagittal planes was 0.495 vs 0.546 and 0.559 vs 0.605, respectively. The results showed that the areas under the curve of ONSD in the transverse and sagittal planes were 0.843 and 0.805, respectively. Medcalc software was used to compare the areas under the receiver operator characteristic curve, and the results showed that ONSD in the sagittal plane is generally better than in the transverse plane (P = 0.0145). This study found that ONSD in the sagittal plane is superior to the transverse plane regarding the comprehensive efficacy of ICP, and unilateral measurement is sufficient.

The effect of minimal and high flow anesthesia on optic nerve sheath diameter in laparotomic gynecological surgery

Background/Aim: Optic nerve sheath diameter (ONSD) is a surrogate parameter for intracranial pressure. This study evaluated the effect of anesthetics on ONSD in women undergoing surgery. We aimed to measure the effect of minimal and high flow anesthesia techniques on expiratory/inspiratory oxygen and carbon dioxide fraction values, hemodynamic parameters, and the optic nerve sheath diameter by ultrasonography in open gynecological surgeries.&#x0D; Methods: In the present prospective cohort study, 80 patients who planned laparotomic gynecological surgery were divided into two groups: a high flow of 2 L/min and a minimum flow of 0.5 L/min. Anesthesia was maintained with 50% oxygen-50% air at 2 L/min and desflurane at 1.1 MAC in Group 1 (n=40) and 50% oxygen-50% air at 0.5 L/min and desflurane at 1.1 MAC in Group 2 (n=40). After 10–15 min, group 2 was administered minimal flow with 50–60% oxygen and 40–50% air at 0.5 L/min desflurane, and 10 min before the end of the surgery, the patients were switched to high flow with 50% oxygen-50% air at 2 L/min.&#x0D; Results: Decreasing heart rates were higher in Group 2 (T0 P=0.001, T2 P=0.007, T3 P=0.035). There was a significant positive correlation between EtCO2 at the 60th min and optic nerve sheath diameter measurements in the minimal flow group (left ONSD r=0.440, P=0.004, right ONSD r=0.473, P=0.002). Although inspiratory oxygen values in Group 2 did not fall below 32%, it was lower than Group 1 except for the last measurement time.&#x0D; Conclusion: Minimal flow anesthesia is as safe as high flow in terms of effects on optic nerve sheath diameter and oxygenation parameters in laparotomic gynecological surgery.

Variability of the optic nerve sheath diameter on brain computed tomography in Turkish children based on sex and age.

Optic nerve sheath diameter (ONSD) measurement is a noninvasive method that can be used for intracranial pressure monitoring. Several studies have investigated normal ONSD values in children, but no general consensus has been reached yet. The aim of our study was to reveal normal ONSD, eyeball transverse diameter (ETD), and ONSD/ETD values on brain computed tomography (CT) in healthy children aged 1month to 18years. Children admitted to the emergency department with minor head trauma and had normal brain CT were included in the study. The demographic characteristics of the patients (age and sex) were recorded, and the patients were divided into four age groups: 1month to 2years, 2 to 4years, 4 to 10years, and 10 to 18years. The images of 332 patients were analyzed. When the median values of all measurement parameters (right and left ONSD, ETD, and ONSD/ETD) were compared between the right and left eyes, no statistically significant differences were found. When the same parameters were compared according to age group, the ONSD and ETD values differed significantly (values of males were found to be higher), but the ONSD proximal/ETD and ONSD middle/ETD values did not differ significantly. In our study, normal ONSD, ETD, and ONSD/ETD values were determined according to age and sex in healthy children. As the ONSD/ETD index did not statistically significantly differ according to age and sex, diagnostic studies for traumatic brain injuries can be performed using the index.

Does prolonged prone position affect intracranial pressure? prospective observational study employing Optic nerve sheath diameter measurements

BackgroundOur aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position.MethodsPatients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients’ pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h.ResultsThe evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001).ConclusionAs a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.

Total diz protezi vaklarında spinal anestezi ve turnike kullanımının optik sinir çapı üzerine etkisi

Abstract: Backgraound: Optic nerve sheath diameter measurement is a non-invasive method that provides rapid results in intracranial pressure assessment. Our aim in this study is to investigate how spinal anesthesia and tourniquet use affect optic nerve sheath diameter values in total knee arthroplasty operations. Methods:30 cases were included in the study. After spinal anesthesia, the tourniquet cuff was inflated. Right and left optic nerve sheath diameter measurements were performed 5 times with ocular ultrasound before spinal anesthesia, after spinal anesthesia, at 10th minutes after tourniquet inflation, 30th minutes after tourniquet inflation, and after tourniquet was deflated. The measurements were recorded in centimeters. During the first 24 hours postoperatively, the patients were followed up for the headache and/or visual impairment. Results: A significant difference was found between optic nerve sheath diameter values before and after spinal anesthesia (p&amp;lt;0.001, p&amp;lt;0.001). When comparing the optical diameter, tourniquet and tourniquet deflation values obtained on the right and left sides over time, we found a linear increase. Conclusion: The use of a tourniquet in spinal anesthesia and orthopedic surgery increases intracranial pressure. Optical measurement of nerve sheath diameter is a non-invasive and successful method that can be used safely for diagnosis and follow-up of elevated intracranial pressure. We believe that anesthesiologists should pay more attention to the measurement of optic nerve sheath diameter in clinical practice.

Diagnostic role of optic nerve sheath diameter and brain blood flow in neonates with hypoxic-ischemic encephalopathy.

The primary aim was to study the optic nerve sheath diameter (ONSD) measurements and cerebral blood flows in neonates with hypoxic-ischemic encephalopathy (HIE) who were at risk of cerebral edema and to compare the measurements with healthy neonates. Neonates diagnosed as Stage II and III HIE patients were enrolled in the study group. ONSD measurements and blood flow Doppler studies in the first 24-48h of life during hypothermia and following hypothermia treatment. Magnetic resonance imaging (MRI) and transfontanelle ultrasonography were performed within the first 4-7days of life in all HIE patients. Saved US and MRI images were assessed by a blind pediatric radiologist later on. Data from a total of 63 infants (42 in the HIE group and 21 in the control group) were analyzed. Both the right and left ONSD measurements were comparable between HIE and control groups. However, both resistive index (RI) and pulsatility index (PI) of the middle cerebral artery were found to be significantly lower in HIE (0.69 ± 0.09 and 1.14 (0.98-1.30)) group when compared with controls (0.75 ± 0.04 and 1.41 (1.25-1.52)) (p < 0.01). Ultrasonographic ONSD measurements were significant and strongly correlated with MRI ONSD measurements for both sides (r = 0.91 and r = 0.93, p < 0.01). Doppler studies during normothermia were comparable with the control group and significantly increased following therapeutic hypothermia. Ultrasonographic ONSD measurements can be reliably performed in term neonates with high compatibility to MRI. No significant effect on ONSD measurements was found related to asphyxia and therapeutic hypothermia despite the significant alteration observed in Doppler studies.

Validation of optic nerve sheath diameter as a bedside noninvasive tool in comparison with lumbar puncture opening pressure in patients suspected of elevated intracranial pressure

Objective The aim was to assess the diagnostic accuracy of optic nerve sheath diameter (ONSD) compared with lumbar puncture opening pressure (LPOP) and computed tomography in diagnosing elevated intracranial pressure (ICP) for critically ill patients. Moreover, the study evaluated the diagnostic ability of ONSD as a screening test for cerebral edema.Background Recently, linear relationships have been detected between ICP and ONSD, proposing ultrasound measurements as a possible noninvasive method.Patients and methods The authors performed a prospective study that included 50 patients with disturbed consciousness of unknown etiology, who were admitted to the ICUs at Beni-Suef University hospital during the period from September 2017 to September 2019. ONSD was measured by ultrasonography.Results Measurement of the right ONSD was 0.62±0.084 cm, whereas measurement of the left ONSD was 0.61±0.083 cm. The mean of two eyes was 0.61±0.09 cm, and the LPOP was 19.96±4.69 cmH2O. Overall, 36 (72%) patients had ONSD greater than 0.6 cm. Besides, 31 (62%) patients had LPOP greater than 20 cmH2O. There was a significant positive correlation between average ONSD and LPOP. Receiver operating characteristic (ROC) curve showed that ONSD greater than 0.6 cm had a diagnostic value of elevated ICP with an area under the curve of 0.872 (95% confidence interval: 0.646–0.936) with a sensitivity of 95% and specificity of 77%, with P-value of 0.001. ROC curve analysis was used for prediction of increased ICP using average ONSD compared with CT where the ROC curve showed that ONSD greater than 0.6 cm had a diagnostic value with an area under the curve of 0.606 (95% confidence interval: 0.51–0.72) with a sensitivity of 83% and specificity of 56%, with P-value of 0.028.Conclusions ONSD is significant in prediction of elevated ICP, with a good positive correlation with LPOP as a gold standard reference.

Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting.

The correlation between imaging findings and clinical status in patients with idiopathic intracranial hypertension is unclear. We aimed to examine the evolution of idiopathic intracranial hypertension-related MR imaging findings in patients treated with venous sinus stent placement. Thirteen patients with idiopathic intracranial hypertension (median age, 26.9 years) were assessed for changes in the CSF opening pressure, transstenotic pressure gradient, and symptoms after venous sinus stent placement. Optic nerve sheath diameter, posterior globe flattening and/or optic nerve protrusion, empty sella, the Meckel cave, tonsillar ectopia, the ventricles, the occipital emissary vein, and subcutaneous fat were evaluated on MR imaging before and 6 months after venous sinus stent placement. Data are expressed as percentages, medians, or correlation coefficients (r) with P values. Although all patients showed significant reductions of the CSF opening pressure (31 versus 21 cm H2O; P = .005) and transstenotic pressure gradient (22.5 versus 1.5 mm Hg; P = .002) and substantial improvement of clinical symptoms 6 months after venous sinus stent placement, a concomitant reduction was observed only for posterior globe involvement (61.5% versus 15.4%; P = .001), optic nerve sheath diameter (6.8  versus 6.1 mm; P < .001), and subcutaneous neck fat (8.9  versus 7.4 mm; P = .001). Strong correlations were observed between decreasing optic nerve sheath diameters and improving nausea/emesis (right optic nerve sheath diameter, r =  0.592, P = .033; left optic nerve sheath diameter, r = 0.718, P = .006), improvement of posterior globe involvement and decreasing papilledema (r = 0.775, P = .003), and decreasing occipital emissary vein diameter and decreasing headache frequency (r = 0.74, P = .035). Decreasing transstenotic pressure gradient at 6 months strongly correlated with decreasing empty sella (r = 0.625, P = .022) and regressing cerebellar ectopia (r = 0.662, P = .019). Most imaging findings persist long after normalization of intracranial pressure and clinical improvement. However, MR imaging findings related to the optic nerve may reflect treatment success.

Ultrasound of the Optic Nerve Does Not Appear to Be a Consistently Reliable or Generalizable Method to Monitor Changes in Intracranial Pressure.

Invasive intracranial pressure (ICP) monitoring is the gold standard, but is not always readily accessible or practical. Ultrasound of the optic nerve sheath diameter (ONSD) has been proposed for detecting both elevation and change in the ICP. Our study is a prospective observational trial that seeks to determine if ultrasound can be reliably used to identify changes in ICP with naturally occurring variations in patient care. A convenience sample of patients with invasive ICP monitoring were enrolled. Patients were identified prior to interventions that were suspected to cause a change in ICP. Measurement of ICP and ONSD was obtained prior to the intervention, with repeated measurements of both variables obtained immediately following the intervention. 36 total patients were enrolled. There was a positive correlation between the ICP and the right ONSD (r = 0.255, P = 0.0003) and the ICP and the left ONSD (r = 0.274, P < 0.0001). There was no statistically significant relationship between the change in either the ICP and the right ONSD (r -0.2 P = 0.282) or left ONSD (r 0.05 P = 0.805). The location of the lesion in the brain appears to significantly affect discordance between the ONSD and the ICP. Ultrasound of the ONSD has shown promise as both a marker of elevated ICP and as a method to identify changes in pressure. Although the size of the ONSD and the measurement of ICP were correlated in our study, the ability to follow changes in ICP was not statistically significant. This indicates that use of ultrasound to track changes in ICP cannot be generalized and may be limited to specific circumstances. The location of the intracranial pathology appears to be a significant factor in discordance between the ICP and ONS diameter.

Optic Nerve Sheath Diameter in Preterm Infants: Suggested Values

Objective: Timely detection of elevated intracranial pressure (ICP) in highrisk preterm infants may be critical to avoid permanent neurologic sequelae. Size of optic nerve sheath diameter (ONSD) is highly correlated with changes in ICP. Normal ultrasonographic ONSD values for preterm infants have been published. This study sought to compare these data with MRI measured OSND and to propose suggested ultrasonographic ONSD values. Methods: The ONSD in preterm MRIs were retrospectively measured and related to pre-existing ultrasonographic ONSD. Data were stratified for corrected gestational age. Simple linear regression between ONSD mean values and age was modeled for both eyes, and R² was calculated. Suggested values for ultrasonographic ONSD were ascertained through linear regression and calculated prediction intervals. Results: ONSD measurements demonstrated R² values of 0.95 (right ONSD MRI), 0.95 (left ONSD MRI), 0.96 (right ONSD ultrasound), and 0.93 (left ONSD ultrasound). Suggested ONSD values were incremental with corrected gestational age. Conclusion: ONSD measurements with MRI and ultrasound are similar. The proposed suggested ONSD values may be helpful in clinical situations where ICPs are suspected or known.

Sonographic Measurement of the Optic Nerve Sheath Diameter (ONSD) and Eyeball Transversal Diameter (ETD) in Benin Healthy African Adults

Background: Measuring optic nerve sheath diameter (ONSD), a relatively re-cent technique, allows an indirect and non-invasive diagnosis of intracranial hypertension. The ONSD ratio to eyeball transverse diameter (ETD) increases this reliability of the technique. The objective of this study was to determine the normal ONSD and its ratio with ETD in black African adults in Benin. Methods: A descriptive cross-sectional study was conducted between May 2019 and August 2019. Ultrasound ONSD and ONSD/ETD ratio were meas-ured in 210 healthy adults received in the medical imaging department of the Borgou and Alibori University Hospital Center in Benin. The ONSD corre-sponded to the average of 12 measurements (03 horizontal and 03 vertical for each eye) taken 3 mm behind the papilla. The transverse ETD corresponded to the average of 03 measurements. Results: The mean ONSD was 4.20 ± 0.28 mm (95% CI = [4.17; 4.24] mm and 95th percentile = 4.70 mm). The mean ETD was 24.25 ± 1.10 mm. The ONSD/ETD ratio was 0.17 ± 0.01 (95% CI = [0.17; 0.17] and 95th percentile = 0.19). There was no difference between ver-tical and horizontal ONSD and between right and left ONSD. The ONSD and the ONSD/ETD ratio were not correlated with any of the socio-demographic and anthropometric characteristics studied (sex, age, ethnicity, weight, height, body mass index, head circumference and waist circumference). The ONSD was associated with ETD (p < 0.001 and r = 0.55). Conclusion: An ONSD and an ONSD/ETD ratio respectively greater than 4.70 mm and 0.19 should sus-pect intracranial hypertension. The ONSD/ETD ratio may be a better indicator of HICT because of its small variation.

Sonographic evaluation of the optic nerve sheath diameter and anterior chamber depth of the eye among apparently healthy adults in Kano, Nigeria

Background: Measurement of optic nerve sheath diameter (ONSD) and anterior chamber depth (ACD) by ultrasound is increasingly used as a marker to detect raised intracranial pressure and other eye pathologies. Knowledge of normal ONSD and ACD in a healthy population is essential in the interpretation of pathological conditions. Aim: The study aimed at evaluating the ONSD and ACD of the eye in apparently healthy adults in Kano State. Materials and Methods: This was a prospective and cross-sectional study conducted among apparently healthy adults in Kano State from April 2019 to October 2019. Using convenience sampling method, 384 adults participated in the study. An ethical approval was obtained from the Human Research and Ethics Committee of the Kano State Ministry of Health, and informed consent was obtained from all the selected participants. A portable digital ultrasound machine, Nortek CS 3 with a 7.5 MHz linear transducer, was used to obtain ACD and ONSD at 3 mm behind the globe, and the values were recorded in data capture sheet. The obtained data were analyzed using SPSS version 23.0. Results: The mean and standard deviation of the right and left ONSDs for males was 4.42 ± 1.38 mm and 4.44 ± 1.41 mm and for the females was 4.39 ± 1.31 mm and 4.41 ± 1.31, respectively. The mean and standard deviation of the right and left ACDs for males was 3.16 ± 0.37 mm and 3.14 ± 0.35 mm and for females was 3.12 ± 0.40 mm and 3.11 ± 1.39 mm, respectively. Conclusion: The study has established normative values for the ONSD and ACD of the eye in Kano State, Nigeria.

Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report.

Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50–78 years). ONSD was measured bilaterally from day 1 to 10 (n = 1), until discharge (n = 3) or death (n = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was calculated on a daily basis as a surrogate formulti-organ failure due to sepsis in the study population. On day 1, the medians of right and left ONSD were 5.56 (IQR 5.35–6.30) mm and 5.68 (IQR 5.50–6.10) mm, respectively, and four subjects had bilaterally elevated ONSD. Forty-nine out of 80 total measurements performed (61%) exceeded 5.7 mm during the study period. We found no correlations between ONSD and sequential organ failure assessment (SOFA) during the study period (right: R = −0.13–0.63; left R = −0.24–0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients.

Optic Nerve Sheath Diameter and Retinal Artery Resistive Index Measurements with Bedside Ophthalmic Ultrasound in Pediatric Patients with Pseudotumor Cerebri Syndrome.

Pseudotumor cerebri syndrome (PTCS) is characterized by raised intracranial pressure (ICP) with no neuroradiological abnormalities. Ocular ultrasound has been in use to measure optic nerve sheath diameter (ONSD), and retinal artery Doppler indices have been used for indirect assessment of ICP by pediatric intensivists. Here, we aimed to evaluate the correlation of the lumbar puncture (LP) opening pressure with the ultrasonographic ONSD and retinal resistive index (RRI) measures in patients with PTCS. And we wanted to find an answer to the following question: Can ultrasonographic ONSD measures serve as a follow-up tool in patients with PTCS? A prospective, single-center, case-control study was performed by pediatric intensive care and pediatric neurology departments. A total of 7 patients with PTCS were evaluated as patient group and 15 healthy children were evaluated as control group. The mean age of patient group was 138.8 ± 43.7 months. The mean right ONSD was 6.7 ± 0.5 mm and the mean left ONSD was 6.7 ± 0.6 mm. The mean right RRI value was 0.73 ± 0.03 and the mean left RRI was 0.73 ± 0.09. For the patient group, ONSD and RRI values of both eyes were statistically significant higher values than for the control group. The mean LP opening pressure was 56.57 ± 16.36 cmH 2 O. We detected strong, positive, and statistically significant correlations between the LP opening pressure and ONSD baseline measures for both the right eye ( r  = 0.882, p  = 0.009) and the left eye ( r  = 0.649, p  = 0.004). There was no correlation between opening pressure in LP and RRI measurements. We detected a statistically significant decrease in the right ONSD and left ONSD values and visual analog scale scores at the third-month follow-up. Our study results demonstrate that ultrasonographic ONSD measurements can be used as a noninvasive tool for assessment of the ICP at first admission and can be used as a follow-up tool in PTSC patients.

Propofol Affects Optic Nerve Sheath Diameter less than Sevoflurane during Robotic Surgery in the Steep Trendelenburg Position.

Background Robot-assisted laparoscopic radical prostatectomy (RLRP) can increase intracranial pressure (ICP) related to a change in position. Increasing ICP may result in various ocular complications, which are rare but serious, such as a corneal abrasion and ischemic optic neuropathy. We performed a prospective observational trial using ultrasonographic measurements to compare optic nerve sheath diameter (ONSD) related to ICP between patients who received either propofol or sevoflurane and underwent RLRP. Methods Thirty-two male patients scheduled to undergo RLRP were assigned into groups according to the anesthetic agent used (group P: propofol, n = 16; group S: sevoflurane, n = 16). ONSD, end-tidal partial pressure of CO2, and blood pressure were measured 10 min after induction of anesthesia (T0), 30 min (T1), 60 min (T2), and 90 min after changing to the steep Trendelenburg position and introducing a pneumoperitoneum (T3) and 10 min after returning the patient's position to supine (T4) during surgery. Results No significant differences were observed in the demographic data of the patients, surgery time, or intraoperative variables, including hemodynamic and respiratory variables, at any of the time points. The mean right ONSDs in the propofol and sevoflurane groups were 37.3 and 40.1 mm at 30 min (p=0.003), respectively. The mean left ONSDs were 38.4 and 40.8 mm at 30 min (p=0.021) after changing to the Trendelenburg position. The ONSDs between the two groups were significantly different during surgery. Conclusions ONSD increased more in the sevoflurane group than in the propofol group during RLRP. Intravenous anesthetics could alleviate the increase in ICP during RLRP.

The Measurement of Elderly Volunteers' Optic Nerve Sheath Diameters by Ocular Ultrasonography.

Background and objectives: The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP. Materials and Methods: The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65–74 years of age; Group 2: 75–84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared. Results: The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups. Conclusions: In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.

Hubungan antara Diameter Optic Nerve Sheath pada Grey Scale Ultrasound dengan Peningkatan Tekanan Intrakranial pada Pasien dengan Lesi Intrakranial

The study aims to determine the correlation between diameter of optic nerve sheath on grey scale with increased intracranial pressure in patients with intracranial lesion. The research was conducted in Radiology Department of Dr. Wahidin Sudirohusodo Makassar from January 2019 – May 2019. The sample were 39 people aged ³18 years old with intracranial lesion. Axial computed tomography (CT) examination was performed to evaluate intracranial lesions and the presence of midline shift. The diameter of the optic nerve sheath was measured using eye ultrasonography. Data analyses used Spearman’s correlation test. The results showed that there was a correlation between the dilatation of the right and left optic nerve sheath diameter with midline shift (p value 0.04; p less than 0.05) on the diameter of the right optic nerve sheath showing a weak positive relationship (p value 0.02) for the diameter the optic nerve sheath left showing a medium positive relationship where the higher the midline shift, the wider the diameter of the left and right optical nerve sheath. There is a correlation between the right and left optic nerve sheath diameter (p less than equal 0.001) showing a strong positive relationship where the wider the diameter of the right optic nerve sheath, the wider the diameter of the left optic nerve sheath at high intracranial pressure. Statistically other results also obtained no relationship between dilatation of the diameter of the optic nerve sheath with clinical symptoms of increased intracranial pressure and type of lesion.