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Diagnostic and prognostic value of the optic nerve sheath diameter with respect to the intracranial pressure and neurological outcome of patients following hemicraniectomy.
BMC Neurol 2018; 18(1):199BN

Abstract

BACKGROUND

In cases showing cerebrospinal fluid (CSF) redistribution as a compensatory mechanism in acute intracranial hypertension, the optic nerve sheath diameter (ONSD) can be used to estimate intracranial pressure (ICP). However, it remains unclear whether the ONSD can be applied in patients with skull defects after a craniectomy, because the primary injury or surgical craniectomy may alter the dynamics of the CSF circulation or structure of the optical nerve sheath. This study explored the value of the ONSD in patients after a hemicraniectomy.

METHODS

This prospective observational study enrolled patients after a hemicraniectomy. All patients underwent invasive ICP monitoring and ocular ultrasound within 6 h postoperatively. We followed the patients for 6 months and evaluated them using the Glasgow Outcome Score (GOS), classifying the outcome as favorable (GOS 4-5) or unfavorable (GOS 1-3). We evaluated the ONSD in both according to the ICP and neurological outcome.

RESULTS

Of the 33 enrolled patients, 20 (60.6%) had an unfavorable outcome at 6 months. Disagreement was seen in the ONSD measurements between the eyes [craniectomy side (ONSDips) and opposite side (ONSDcon)]. The intraclass correlation coefficient between ONSDips and ONSDcon was 0.745 (p < 0.001). ONSD had no significant correlation with ICP in Spearman correlation analysis (ONSDips r = 0.205, p = 0.252; ONSDcon r = 0.164, p = 0.362). Receiver operator characteristic (ROC) curve analysis revealed that the GCS, Helsinki computed tomography (CT) score, pupil reaction, and ONSDcon measured after the craniectomy were significantly associated with a poor outcome. ONSDcon > 5.5 mm predicted a poor outcome, with an area under the ROC curve of 0.717 (95% confidence interval, 0.534-0.860, p = 0.02), 70% sensitivity, and 69.2% specificity.

CONCLUSIONS

After hemicraniectomy, the ONSD measured on ultrasound was unreliable for evaluating ICP, but showed potential prognostic value for a poor neurological outcome.

Authors+Show Affiliations

Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China.Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China.Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China.Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China.Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China. z2jzk@zju.edu.cn.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30518315

Citation

Gao, Yuzhi, et al. "Diagnostic and Prognostic Value of the Optic Nerve Sheath Diameter With Respect to the Intracranial Pressure and Neurological Outcome of Patients Following Hemicraniectomy." BMC Neurology, vol. 18, no. 1, 2018, p. 199.
Gao Y, Li Q, Wu C, et al. Diagnostic and prognostic value of the optic nerve sheath diameter with respect to the intracranial pressure and neurological outcome of patients following hemicraniectomy. BMC Neurol. 2018;18(1):199.
Gao, Y., Li, Q., Wu, C., Liu, S., & Zhang, M. (2018). Diagnostic and prognostic value of the optic nerve sheath diameter with respect to the intracranial pressure and neurological outcome of patients following hemicraniectomy. BMC Neurology, 18(1), p. 199. doi:10.1186/s12883-018-1202-5.
Gao Y, et al. Diagnostic and Prognostic Value of the Optic Nerve Sheath Diameter With Respect to the Intracranial Pressure and Neurological Outcome of Patients Following Hemicraniectomy. BMC Neurol. 2018 Dec 5;18(1):199. PubMed PMID: 30518315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic and prognostic value of the optic nerve sheath diameter with respect to the intracranial pressure and neurological outcome of patients following hemicraniectomy. AU - Gao,Yuzhi, AU - Li,Qiang, AU - Wu,Chunshuang, AU - Liu,Shaoyun, AU - Zhang,Mao, Y1 - 2018/12/05/ PY - 2018/01/17/received PY - 2018/11/20/accepted PY - 2018/12/7/entrez PY - 2018/12/7/pubmed PY - 2019/1/15/medline KW - Hemicraniectomy KW - Intracranial pressure KW - Neurological outcome KW - Optical nerve sheath diameter SP - 199 EP - 199 JF - BMC neurology JO - BMC Neurol VL - 18 IS - 1 N2 - BACKGROUND: In cases showing cerebrospinal fluid (CSF) redistribution as a compensatory mechanism in acute intracranial hypertension, the optic nerve sheath diameter (ONSD) can be used to estimate intracranial pressure (ICP). However, it remains unclear whether the ONSD can be applied in patients with skull defects after a craniectomy, because the primary injury or surgical craniectomy may alter the dynamics of the CSF circulation or structure of the optical nerve sheath. This study explored the value of the ONSD in patients after a hemicraniectomy. METHODS: This prospective observational study enrolled patients after a hemicraniectomy. All patients underwent invasive ICP monitoring and ocular ultrasound within 6 h postoperatively. We followed the patients for 6 months and evaluated them using the Glasgow Outcome Score (GOS), classifying the outcome as favorable (GOS 4-5) or unfavorable (GOS 1-3). We evaluated the ONSD in both according to the ICP and neurological outcome. RESULTS: Of the 33 enrolled patients, 20 (60.6%) had an unfavorable outcome at 6 months. Disagreement was seen in the ONSD measurements between the eyes [craniectomy side (ONSDips) and opposite side (ONSDcon)]. The intraclass correlation coefficient between ONSDips and ONSDcon was 0.745 (p < 0.001). ONSD had no significant correlation with ICP in Spearman correlation analysis (ONSDips r = 0.205, p = 0.252; ONSDcon r = 0.164, p = 0.362). Receiver operator characteristic (ROC) curve analysis revealed that the GCS, Helsinki computed tomography (CT) score, pupil reaction, and ONSDcon measured after the craniectomy were significantly associated with a poor outcome. ONSDcon > 5.5 mm predicted a poor outcome, with an area under the ROC curve of 0.717 (95% confidence interval, 0.534-0.860, p = 0.02), 70% sensitivity, and 69.2% specificity. CONCLUSIONS: After hemicraniectomy, the ONSD measured on ultrasound was unreliable for evaluating ICP, but showed potential prognostic value for a poor neurological outcome. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/30518315/Diagnostic_and_prognostic_value_of_the_optic_nerve_sheath_diameter_with_respect_to_the_intracranial_pressure_and_neurological_outcome_of_patients_following_hemicraniectomy_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1202-5 DB - PRIME DP - Unbound Medicine ER -