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.
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The author(s) received no financial support for the research, authorship, and/or publication of this article.
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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.
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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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DOI: https://doi.org/10.1007/s12028-019-00853-x