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Diagnostic Value of the Combination of Ultrasonographic Optic Nerve Sheath Diameter and Width of Crural Cistern with Respect to the Intracranial Pressure in Patients Treated with Decompressive Craniotomy

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A Letters to the editor to this article was published on 19 October 2023

A Response to Letter To The Editor to this article was published on 19 October 2023

Abstract

Background

The monitoring of intracranial pressure (ICP) and detection of increased ICP are crucial because such increases may cause secondary brain injury and a poor prognosis. Although numerous ultrasound parameters, including optic nerve sheath diameter (ONSD), width of the crural cistern (WCC), and the flow velocities of the central retinal artery and middle cerebral artery, can be measured in patients after hemicraniectomy, researchers have yet to determine which of these is better for evaluating ICP. This study aimed to analyze the correlation between ICP and ultrasound parameters and investigate the best noninvasive estimator of ICP.

Methods

This observational study enrolled 50 patients with brain injury after hemicraniectomy from January 2021 to December 2021. All patients underwent invasive ICP monitoring with microsensor, transcranial, and ocular ultrasound postoperatively. We measured the ONSD including the dura mater (ONSDI), the ONSD excluding the dura mater, the optic nerve diameter (OND), the eyeball transverse diameter (ETD), the WCC, and the flow velocities in the central retinal artery and middle cerebral artery. Then, we calculated the ONSDI-OND (the difference between ONSDI and OND) and ONSDI/ETD (the ratio of ONSDI to ETD). Patients were divided into a normal ICP group (n = 35) and an increased ICP group (≥ 20 mm Hg, n = 15) according to the ICP measurements. Correlations were then assessed between the values of the ultrasound parameters and ICP.

Results

The ONSDI, ONSDI-OND, and ONSDI/ETD were positively associated with ICP (r = 0.455, 0.482, 0.423 and p = 0.001, < 0.001, 0.002, respectively), whereas the WCC was negatively associated with ICP (r = − 0.586, p < 0.001). The WCC showed the highest predictive power for increased ICP (area under the receiver operating characteristic curve [AUC] = 0.904), whereas the ONSDI-OND and ONSDI also presented with acceptable predictive power among the ONSD-related parameters (AUC = 0.831, 0.803, respectively). The cutoff values for increased ICP prediction for ONSDI, ONSDI-OND, and WCC were 6.29, 3.03, and 3.68 mm, respectively. The AUC of the combination of ONSDI-OND and WCC was 0.952 (95% confidence interval 0.896–1.0, p < 0.001).

Conclusions

The ONSDI, ONSDI-OND, and WCC were correlated with ICP and had acceptable accuracy levels in estimating ICP in patients after hemicraniectomy. Furthermore, WCC showed a higher diagnostic value than ONSD-related parameters, and the combination of ONSDI-OND and WCC was a satisfactory predictor of increased ICP.

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Abbreviations

ICP:

Intracranial pressure

ONSD:

Optic nerve sheath diameter

WCC:

Width of crural cistern

CRA:

Central retinal artery

MCA:

Middle cerebral artery

ONSDI:

ONSD including the dura mater

ONSDE:

ONSD excluding the dura mater

OND:

Optic nerve diameter

ETD:

Eyeball transverse diameter

AUC:

Area under the curve

ROC:

Receiver operating characteristic

PSV:

Peak systolic velocity

EDV:

End-diastolic velocity

MFV:

Mean flow velocity

RI:

Resistance index

PI:

Pulsatility index

MDC:

Minimal detectable changes

ICC:

Intraclass correlation coefficient

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Funding

There was no funding associated with this study.

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Authors and Affiliations

  1. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Xiaolan Xu, Yajing Lu, Jiqiao Liu, Renfan Xu & Anyu Tao

  2. Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

    Kai Zhao

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  1. Xiaolan Xu
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  2. Yajing Lu
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  4. Renfan Xu
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Contributions

XX, KZ, and AT conceived and designed the study. YL and JL performed the experiments and analyzed the data. XX wrote the article. XX, RX, and AT reviewed and edited the manuscript. All authors discussed the results and approved the final manuscript.

Corresponding author

Correspondence to Anyu Tao.

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Conflicts of Interest

The authors declare that they have no conflicts of interest to this work.

Ethical Approval

This study was approved by the research ethics boards of Tongji Hospital Affiliated with Huazhong University of Science and Technology. According to the ethics standards of the institutional committee, the caregivers of all enrolled patients signed informed consent forms.

Informed Consent

We confirmed that this manuscript complies with all instructions to authors. All authors discussed the results and approved the manuscript. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously and not under consideration for publication elsewhere, in whole or in part.

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Xu, X., Lu, Y., Liu, J. et al. Diagnostic Value of the Combination of Ultrasonographic Optic Nerve Sheath Diameter and Width of Crural Cistern with Respect to the Intracranial Pressure in Patients Treated with Decompressive Craniotomy. Neurocrit Care 39, 436–444 (2023). https://doi.org/10.1007/s12028-023-01711-7

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