Montorfano Lisandro, Yu Qian, Bordes Stephen J, Sivanushanthan Shankarapryan, Rosenthal Raul J, Montorfano Miguel
Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA.
School of Medicine, Georgetown University, Washington D.C, USA.
Ultrasound J. 2021 Jul 2;13(1):35. doi: 10.1186/s13089-021-00235-5.
Timely diagnosis and treatment of increased intracranial pressure can decrease morbidity and prevent mortality. The present meta-analysis aims to determine the mean value of the ONSD measured in patients with various elevated ICP etiologies under different clinical settings, as well as comparing the value of ONSD between patients with and without elevated ICP.
This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement8. PubMed, Embase, and Cochrane Library were searched to identify ONSD measured by US for patients with increased ICP from establishment to October 2020.
A total of 779 patients with elevated ICP among 22 studies were included in the present meta-analysis. Studies were published between 2003 and 2020. Eighteen were comparative (18/22, 81.8%), and four were single-armed study (4/22, 18.2%). Twenty were prospective studies (20/22, 90.9%). There was moderate-to-high heterogeneity based on the prediction ellipse area and variance logit of sensitivity and specificity.
The mean value of the ONSD among patients diagnosed with increased ICP was 5.82 mm (95% CI 5.58-6.06 mm). Variations were observed based on etiology of intracranial hypertension, clinical settings where ONSD was measured, and standards for diagnosing intracranial hypertension. The US-ONSD among patient with elevated ICP was significantly higher than the normal control. Although a cut-off value is not clearly determined, these mean values can be implemented to evaluate the sensitivity and specificity of US-ONSD in diagnosing intracranial hypertension in future studies.
及时诊断和治疗颅内压升高可降低发病率并预防死亡。本荟萃分析旨在确定在不同临床环境下各种颅内压升高病因患者中测量的视神经鞘直径（ONSD）的平均值，并比较颅内压升高和未升高患者之间的ONSD值。
本荟萃分析遵循系统评价和荟萃分析的首选报告项目声明8。检索了PubMed、Embase和Cochrane图书馆，以确定从建库至2020年10月期间通过超声测量的颅内压升高患者的ONSD。
本荟萃分析纳入了22项研究中的779例颅内压升高患者。研究发表于2003年至2020年之间。18项为比较性研究（18/22，81.8%），4项为单臂研究（4/22，18.2%）。20项为前瞻性研究（20/22，90.9%）。基于预测椭圆面积以及敏感性和特异性的方差对数，存在中度至高度异质性。
诊断为颅内压升高的患者中ONSD的平均值为5.82毫米（95%置信区间5.58 - 6.06毫米）。基于颅内高压的病因、测量ONSD的临床环境以及颅内高压的诊断标准观察到了差异。颅内压升高患者的超声测量ONSD显著高于正常对照。尽管尚未明确确定临界值，但这些平均值可用于评估未来研究中超声测量ONSD诊断颅内高压的敏感性和特异性。
