Effects of prone positioning with neck extension on intracranial pressure according to optic nerve sheath diameter measured using ultrasound in children

  • Soo-Bin Yoon
  • Sang-Hwan Ji
  • Young-Eun Jang
  • Ji-Hyun Lee
  • Eun-Hee Kim
  • Jin-Tae Kim
  • Hee-Soo KimEmail author
Original Article



Optic nerve sheath diameter has been used for measure of intracranial pressure. The aim of this study was to evaluate the effect of prone positioning with neck extension on intracranial pressure in infants undergoing craniosynostosis surgery and to determine precautions using optic nerve sheath diameter measurement.


We enrolled 30 infants who were scheduled for correction of craniosynostosis in which planning included the prone position with neck extension. Optic nerve sheath diameter (anterior/lateral transbulbar approach) was measured 5 times in each eyeball at the following time points: 15 min after intubation in supine position as the baseline value (supine 1); 10 min after final surgical position before skin incision (prone); and 10 min after returning to supine position at the conclusion of surgery (supine 2). Hemodynamic parameters, airway peak pressure, oxygen saturation, and ETCO2 were monitored. Data were analyzed using repeated-measures multivariate analysis of variance to evaluate the effect of different positions under anesthesia on changes in using optic nerve sheath diameter and P < 0.05 was considered to be statistically significant.


There was no difference in optic nerve sheath diameter after prone position with neck extension in all the measure. After surgery, optic nerve sheath diameter was decreased compared with the preoperative baseline values (Rt anterior/lateral 5.6/5.5: 5.4/5.2; Lt anterior/lateral 5.6/5.5: 5.4/5.3, P < 0.05, respectively).


In conclusion, prone positioning with head extension did not further increase intracranial pressure, although the surgical procedure could reduce intracranial pressure in the immediate postoperative period in infants undergoing craniosynostosis surgery.


Children Optic nerve sheath diameter Prone position 


Author contributions

Soobin Yoon, MD, helped write and edit the manuscript. Sang-Hwan Ji, MD, helped in the ONSD measurement and in editing the manuscript. Young-Eun Jang Yoon, MD, helped in the ONSD measurement and in editing the manuscript. Eun-Hee Kim, MD, helped in the ONSD measurement and statistics results. Ji-Hyun Lee, MD, PhD, helped in the study design and in editing the manuscript. Jin-Tae Kim, MD, PhD, helped in writing the study and in editing the manuscript. Hee-Soo Kim, MD, PhD, designed the study and edited the manuscript.

Compliance with ethical standards

The study protocol was approved by the Institutional Review Board at Seoul National University Hospital (SNUH IRB 1703-147-840, April 2017).

Conflict of interest

None declared.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Soo-Bin Yoon
    • 1
  • Sang-Hwan Ji
    • 1
  • Young-Eun Jang
    • 1
  • Ji-Hyun Lee
    • 1
  • Eun-Hee Kim
    • 1
  • Jin-Tae Kim
    • 2
  • Hee-Soo Kim
    • 2
    Email author
  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Anesthesiology and Pain Medicine, College of MedicineSeoul National UniversitySeoulRepublic of Korea

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