Wang Juxiang, Li Ke, Li Hongjia, Ji Chengyi, Wu Ziyao, Chen Huimin, Chen Bin
1Department of Intensive Care Unit, Xiamen Cardiovascular Hospital, Xiamen University.
2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine.
J Neurosurg. 2019 Jul 19;133(2):514-520. doi: 10.3171/2019.4.JNS183297. Print 2020 Aug 1.
Increased intracranial pressure (ICP) results in enlarged optic nerve sheath diameter (ONSD). In this study the authors aimed to assess the association of ONSD and ICP in severe traumatic brain injury (TBI) after decompressive craniotomy (DC).
ONSDs were measured by ocular ultrasonography in 40 healthy control adults. ICPs were monitored invasively with a microsensor at 6 hours and 24 hours after DC operation in 35 TBI patients. ONSDs were measured at the same time in these patients. Patients were assigned to 3 groups according to ICP levels, including normal (ICP ≤ 13 mm Hg), mildly elevated (ICP = 14-22 mm Hg), and severely elevated (ICP > 22 mm Hg) groups. ONSDs were compared between healthy control adults and TBI cases with DC. Then, the association of ONSD with ICP was analyzed using Pearson's correlation coefficient, linear regression analysis, and receiver operator characteristic curves.
Seventy ICP measurements were obtained among 35 TBI patients after DC, including 25, 27, and 18 measurements in the normal, mildly elevated, and severely elevated ICP groups, respectively. Mean ONSDs were 4.09 ± 0.38 mm in the control group and 4.92 ± 0.37, 5.77 ± 0.41, and 6.52 ± 0.44 mm in the normal, mildly elevated, and severely elevated ICP groups, respectively (p < 0.001). A significant linear correlation was found between ONSD and ICP (r = 0.771, p < 0.0001). Enlarged ONSD was a robust predictor of elevated ICP. With an ONSD cutoff of 5.48 mm (ICP > 13 mm Hg), sensitivity and specificity were 91.1% and 88.0%, respectively; a cutoff of 5.83 mm (ICP > 22 mm Hg) yielded sensitivity and specificity of 94.4% and 81.0%, respectively.
Ultrasonographic ONSD is strongly correlated with invasive ICP measurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after DC.
颅内压（ICP）升高会导致视神经鞘直径（ONSD）增大。在本研究中，作者旨在评估减压颅骨切开术（DC）后严重创伤性脑损伤（TBI）患者中ONSD与ICP之间的关联。
对40名健康对照成年人进行眼部超声测量ONSD。在35例TBI患者DC手术后6小时和24小时，使用微传感器进行有创ICP监测。同时测量这些患者的ONSD。根据ICP水平将患者分为3组，包括正常（ICP≤13mmHg）、轻度升高（ICP = 14 - 22mmHg）和重度升高（ICP>22mmHg）组。比较健康对照成年人与接受DC的TBI病例之间的ONSD。然后，使用Pearson相关系数、线性回归分析和受试者工作特征曲线分析ONSD与ICP之间的关联。
35例TBI患者DC术后共获得70次ICP测量值，正常、轻度升高和重度升高ICP组分别为25次、27次和18次。对照组平均ONSD为4.09±0.38mm，正常、轻度升高和重度升高ICP组分别为4.92±0.37mm、5.77±0.41mm和6.52±0.44mm（p<0.001）。ONSD与ICP之间存在显著线性相关性（r = 0.771，p<0.0001）。ONSD增大是ICP升高的有力预测指标。以5.48mm为ONSD临界值（ICP>13mmHg）时，敏感性和特异性分别为91.1%和88.0%；以5.83mm为临界值（ICP>22mmHg）时，敏感性和特异性分别为94.4%和81.0%。
超声测量的ONSD与有创ICP测量值密切相关，可作为检测DC术后TBI患者ICP升高的一种敏感且无创的方法。
