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A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol

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A Letters to the editor to this article was published on 28 September 2023

A Response to Letter To The Editor to this article was published on 28 September 2023

Abstract

Measuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protocol associated with equipment specifications, as a guide to minimize the occurrence of such artifacts enabling a more reliable and accurate measurement. We suggest that color Doppler could be used as a new standard evaluation for the ONSD.

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Abbreviations

ALARA:

As low as reasonably achievable

CRA:

Central retinal artery

CRV:

Central retinal vein

ICP:

Intracranial pressure

ICU:

Intensive care unit

IIH:

Idiopathic intracranial hypertension

iNPH:

Idiopathic normal pressure hydrocephalus

I SPTA.3 :

Spatial-peak temporal-average intensity

MI:

Mechanical index

ms:

Millisecond

ON:

Optic nerve

ONSD:

Optic nerve sheath diameter

PRF:

Pulse repetition frequency

SAH:

Subarachnoid hemorrhage

TI:

Thermal index

TIC:

Thermal index cranium

TIS_as:

Soft tissue thermal index at surface

US:

Ultrasound

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Acknowledgements

We thank Dr. Monica Ferri for color Doppler learning skills, Dr. Veronica Salvatore for assistance with US settings support, and Dr. Franziska Lohmeyer for the revision of our manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

Authors

Contributions

Aspide, Bertolini was involved in conception and design. Aspide, Bertolini, Albini was involved in acquisition of data. Aspide, Bertolini, Biasucci contributed in drafting the article. All authors critically revised the article and reviewed the submitted version of manuscript. Albini was also involved in Technical/material support. Mazzatenta, Palandri, and Biasucci contributed in study supervision.

Corresponding author

Correspondence to Raffaele Aspide.

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Conflicts of Interest

The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

The local Institutional Review Board approved the present study. CLOSED protocol adhered to ethical standards and Helsinki Declaration.

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Aspide, R., Bertolini, G., Albini Riccioli, L. et al. A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol. Neurocrit Care 32, 327–332 (2020). https://doi.org/10.1007/s12028-019-00853-x

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