Ultrasonographic Assessment of Optic Nerve Sheath Diameter as a Screening Tool for Intracranial Hypertension in Traumatic Brain Injury.

Autor: Lioi F; Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. Electronic address: lioifrancesco@gmail.com., Ramm-Pettersen J; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway., Fratini A; Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy., Riva C; Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy., Colella N; Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy., Missori P; Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Dec; Vol. 192, pp. e42-e48. Date of Electronic Publication: 2024 Aug 27.
DOI: 10.1016/j.wneu.2024.08.111
Abstrakt: Background: Severe traumatic brain injury (TBI) is a condition burdened by high morbidity and mortality. Prevention of secondary insults is 1 of the main goals of management and intracranial pressure (ICP) monitoring is a cornerstone in management of TBI. The relationship between ICP and optic nerve sheath is known from the literature. Optic nerve sheath ultrasonography could represent a method added to our armamentarium for monitoring ICP.
Methods: We investigated how ultrasound-measured optic nerve sheath diameter (ONSD) varies as a function of ICP in a cohort of patients with severe blunt head injury in whom an intraparenchymal sensor was placed. We evaluated the accuracy of ONSD in distinguishing dichotomized ICP cut-offs and analyzed the learning curve and its potential as screening tool to select TBI patients most in need of invasive ICP monitoring in a setting with constraints on resources.
Results: ONSD and ICP have a linear relationship. Nevertheless, there are limits of evaluating the one-to-one correspondence between those 2 variables. We selected a cut-off of sonographic ONSD above which there is a concernable elevation of ICP (ICP >15 mmHg) worthy of invasive second-line monitoring. Thus, it is possible to use ONSD as a first-line noninvasive tool to intercept patients at risk of developing frank intracranial hypertension.
Conclusions: We propose the use of ONSD ultrasound as a screening investigation for post-traumatic intracranial hypertension in the context of an emergency department, especially in contexts where there is limited availability of ICP monitors.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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