Optic nerve sheath diameter [Neurosurgery Wiki]

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====== Optic nerve sheath diameter ======

Dilatation of the [[optic nerve sheath]] has been shown to be a much earlier manifestation of [[ICP]] rise
((Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87:34–40.))
((Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1966;26:701–5.)).

ONSD is a simple noninvasive measurement on initial CT in patients with TBI that could be a surrogate for ICP monitoring. However, further studies are warranted
((Al-Hassani A, Strandvik G, Abayazeed S, Ahmed K, El-Menyar A, Mahmood I, Arumugam SK, Asim M, Nabir S, Ahmed N, Ahmed Z, Al-Thani H. Relationship of Optic Nerve Sheath Diameter and Intracranial Hypertension in Patients with Traumatic Brain Injury. J Emerg Trauma Shock. 2020 Jul-Sep;13(3):183-189. doi: 10.4103/JETS.JETS_103_19. Epub 2020 Sep 18. PMID: 33304067; PMCID: PMC7717459.)).
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Maissan et al. found that the [[optic nerve sheath diameter]] was distended during and after [[endotracheal intubation]] (ETI) in anesthetized patients, and intravenous [[lidocaine]] attenuated this effect
((Maissan IM, Hollestelle RV, Rijs K, Jaspers S, Hoeks S, Haitsma IK, den Hartog D, Stolker RJ. Intravenous lidocaine attenuates distention of the optical nerve sheath, a correlate of intracranial pressure, during endotracheal intubation. Minerva Anestesiol. 2022 Oct 26. doi: 10.23736/S0375-9393.22.16574-0. Epub ahead of print. PMID: 36287389.)).
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For Liu et al. ONSD measured via head CT correlates with ICP and can predict the requirement for surgery in patients with [[TBI]] following [[admission]] to the [[emergency department]]
((Liu M, Yang ZK, Yan YF, Shen X, Yao HB, Fei L, Wang ES. Optic nerve sheath
measurements by computed tomography to predict intracranial pressure and guide
surgery in patients with traumatic brain injury. World Neurosurg. 2019 Oct 17.
pii: S1878-8750(19)32683-X. doi: 10.1016/j.wneu.2019.10.065. [Epub ahead of
print] PubMed PMID: 31629929.
)).
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In a study of Agrawal et al. [[optic nerve sheath diameter]] demonstrated a modest, statistically significant correlation with [[intracranial pressure]], a predetermined level of diagnostic accuracy to justify routine clinical use as a screening test was not achieved. Measurement of [[optic disc]] elevation appears promising for the detection of elevated intracranial pressure, however, verification from larger studies is necessary
((Agrawal D, Raghavendran K, Zhao L, Rajajee V. A Prospective Study of Optic Nerve Ultrasound for the Detection of Elevated Intracranial Pressure in Severe Traumatic Brain Injury. Crit Care Med. 2020 Oct 13. doi: 10.1097/CCM.0000000000004689. Epub ahead of print. PMID: 33048902.)).

===== Optic nerve sheath diameter ultrasonography =====

see [[Optic nerve sheath diameter ultrasonography]].

===== References =====