The Significance of Optic Nerve Ultrasonography In Intracranial Hypertension
Keywords:
Optic Nerve Ultrasonography, Intracranial Hypertension Diagnosis, ONSD Measurement Technique, Non-Invasive ICP Assessment, Traumatic Brain Injury Monitoring, Cerebral Edema Management, Neurocritical Care UltrasoundAbstract
Intracranial hypertension (ICH) is a life-threatening complication of both traumatic and non-traumatic brain injuries. Invasive intracranial pressure (ICP) monitoring remains the diagnostic gold standard but is often impractical in resource-limited settings due to associated risks and costs. Despite global interest in non-invasive alternatives, there is limited clinical data from Uzbekistan evaluating the efficacy of optic nerve sheath diameter (ONSD) ultrasonography for ICH diagnosis and management. This prospective study enrolled 34 patients with suspected ICH at the Namangan Branch of the Republican Research Centre of Emergency Medicine. Participants were divided into two groups: Group A received ONSD-guided treatment based on ultrasonographic assessment; Group B was managed by clinical signs alone. Clinical outcomes, ICU stay, and complication rates were analyzed. ONSD values above 5.5 mm were considered indicative of elevated ICP. Group A showed faster symptom resolution, reduced ICU stay (5.2 vs. 7.8 days), and fewer complications. Notably, 95% of patients in Group A achieved ICP reduction within 24 hours, compared to 68% in Group B. The study supports ONSD ultrasonography as a reliable, non-invasive tool for early ICP detection and management. It demonstrates improved clinical outcomes when ONSD measurements guide treatment decisions. These findings highlight the technique's value in neurocritical care, particularly in settings with limited access to invasive monitoring. Further multicenter studies are warranted to validate these findings and standardize implementation. Intracranial hypertension (ICH) is a common and critical complication in patients with traumatic brain injury (TBI) and non-traumatic cerebral pathologies. The gold standard for diagnosing ICH is invasive intracranial pressure (ICP) monitoring. However, its invasive nature, high cost, and risk of infection and hemorrhagic complications limit its widespread application. This study explores the clinical utility of optic nerve sheath diameter (ONSD) measurement using ultrasonography (US) as a non-invasive, accessible, and reliable diagnostic tool for detecting elevated ICP. A prospective study involving 34 patients with cerebral pathology was conducted. Patients were divided into two groups: Group A underwent ONSD ultrasonographic assessment, and treatment decisions were made accordingly; Group B received treatment based on clinical signs alone. The results demonstrate that patients in Group A showed significantly better therapeutic outcomes, with 95% achieving ICP reduction within 24 hours. Ultrasonographic assessment of ONSD proves to be a valuable and efficient tool for managing patients with suspected intracranial hypertension in neurocritical care settings.
References
Abbinante, G. (2023). Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics, 13(3). https://doi.org/10.3390/diagnostics13030535
Andreytseva, M.I. (2018). The ultrasound study of the optic canal for detecting raised intracranial pressure (a literature review and critical analysis). Russian Sklifosovsky Journal of Emergency Medical Care, 7(4), 349–356. https://doi.org/10.23934/2223-9022-2018-7-4-349-356
Bozdoğan, Z. (2023). Comparison of Optic Nerve Sheath Diameters Measured by Optic Ultrasonography Before and After Lumbar Puncture in Idiopathic Intracranial Hypertension Patients. Noropsikiyatri Arsivi, 60(2), 117–123. https://doi.org/10.29399/npa.28074
Dubourg, M., Ghorbani, F., Jabre, S., et al. (2011). Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: A systematic review and meta-analysis. Intensive Care Medicine, 37, 1059–1068. https://doi.org/10.1007/s00134-011-2224-2
Fan, W.Z. (2024). Advancements in Ultrasound Techniques for Evaluating Intracranial Pressure Through Optic Nerve Sheath Diameter Measurement. World Neurosurgery, 189, 285–290. https://doi.org/10.1016/j.wneu.2024.06.087
Kazdal, H. (2016). Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Intracranial Midline Shift in Patients with Head Trauma. World Neurosurgery, 85, 292–297. https://doi.org/10.1016/j.wneu.2015.10.015
Kerscher, M., McAllister, A., Pacheco, P., et al. (2019). Diagnostic accuracy of optic nerve sheath diameter ultrasonography for elevated intracranial pressure: Systematic review and meta-analysis. Acta Neurochirurgica, 161, 1203–1213. https://doi.org/10.1007/s00701-019-03908-8
Kimberly, M., & Noble, J. (2008). Using ultrasound to assess optic nerve sheath diameter. Critical Care, 12(5), R67. https://doi.org/10.1186/cc7006
Koziarz, H. M., Sne, M., Gavrilovic, S., et al. (2019). Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: A systematic review and meta-analysis. Journal of Ultrasound in Medicine, 38(7), 1653–1664. https://doi.org/10.1002/jum.14896
Lochner, A., Czosnyka, M., Naldi, Z., et al. (2021). Assessment of intracranial pressure by optic nerve sheath diameter measured by transorbital ultrasonography: A systematic review and meta-analysis. Neurosurgical Review, 44, 1891–1904. https://doi.org/10.1007/s10143-020-01330-9
Maissan, A., Dirven, G., Haitsma, T., et al. (2015). Ultrasonographic measurement of optic nerve sheath diameter in healthy volunteers and its implication for diagnosing elevated intracranial pressure. Critical Ultrasound Journal, 7(1), 3. https://doi.org/10.1186/s13089-015-0023-0
Martínez-Palacios, K. (2024). Using Optic Nerve Sheath Diameter for Intracranial Pressure (ICP) Monitoring in Traumatic Brain Injury: A Scoping Review. Neurocritical Care, 40(3), 1193–1212. https://doi.org/10.1007/s12028-023-01884-1
Moraes, F.M. de (2023). Multimodal monitoring intracranial pressure by invasive and noninvasive means. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-45834-5
Orgun, L. Tekin (2020). Optic nerve ultrasonography in monitoring treatment efficacy in pediatric idiopathic intracranial hypertension. Child's Nervous System, 36(7), 1425–1433. https://doi.org/10.1007/s00381-019-04497-2
Palermo, J. (2020). Point-of-care handheld ophthalmic ultrasound in the diagnosis and evaluation of raised intracranial pressure and Terson syndrome: a description of two cases. Canadian Journal of Anesthesia, 67(3), 353–359. https://doi.org/10.1007/s12630-019-01531-4
Papanikolaou, P., Loutas, T., Papadopoulos, P., et al. (2021). Optic nerve sheath diameter ultrasonography in neurocritical care: A systematic review. Journal of Clinical Monitoring and Computing, 35, 1–12. https://doi.org/10.1007/s10877-020-00517-7
Raboel, J., Bartek, M., Andresen, J., et al. (2012). Intracranial pressure monitoring: Invasive versus non-invasive methods—a review. Critical Care Research and Practice, 2012, Article ID 950393. https://doi.org/10.1155/2012/950393
Rajajee, N., Williamson, D., Fontes, C., et al. (2011). Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocritical Care, 15(3), 506–515. https://doi.org/10.1007/s12028-011-9606-8
Rajajee, V. (2024). Noninvasive Intracranial Pressure Monitoring: Are We There Yet?. Neurocritical Care, 41(2), 332–338. https://doi.org/10.1007/s12028-024-01951-1
Robba, M., Cardim, R., Tajsic, A., et al. (2018). Non-invasive assessment of intracranial pressure. Acta Neurochirurgica Supplement, 126, 69–73. https://doi.org/10.1007/978-3-319-65442-7_13
Robba, P., Cardim, A., Sekhon, C., et al. (2018). Optic nerve sheath diameter ultrasonography for elevated intracranial pressure: A review. Journal of Neurosurgical Anesthesiology, 30(3), 198–208. https://doi.org/10.1097/ANA.0000000000000451
Robba, P., Santori, T., Bragazzi, E., et al. (2021). Optic nerve sheath diameter ultrasonography: A promising tool for non-invasive assessment of intracranial pressure. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.717919
Saz-Saucedo, P. Del (2016). Sonographic assessment of the optic nerve sheath diameter in the diagnosis of idiopathic intracranial hypertension. Journal of the Neurological Sciences, 361, 122–127. https://doi.org/10.1016/j.jns.2015.12.032
Sekhon, T., & Griesdale, J. (2019). Optic nerve sheath diameter on ultrasound for the detection of elevated intracranial pressure: A systematic review and meta-analysis. Canadian Journal of Anesthesia, 66, 1215–1227. https://doi.org/10.1007/s12630-019-01410-7
Soldatos, B., Karakitsos, P., Chatzimichail, A., et al. (2008). Optic nerve sonography in the diagnostic evaluation of adult brain injury. Critical Care, 12(3), R67. https://doi.org/10.1186/cc6945
Wang, J., Li, R., Zhao, L., et al. (2017). Ultrasound measurement of optic nerve sheath diameter to detect intracranial pressure in children. Pediatrics, 139(1), e20162858. https://doi.org/10.1542/peds.2016-2858
