Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania.
Acta Neurochir (Wien). 2022 Jul;164(7):1755-1764. doi: 10.1007/s00701-022-05234-6. Epub 2022 May 21.
We aimed to quantitatively assess Evans index (EI) using ultrasonographic optic nerve sheath diameter (ONSD) measurements in supine and upright position in normal pressure hydrocephalus (NPH) patients.
Ultrasonographically ONSD was measured in a supine and upright position before and 4-5 days after the ventriculoperitoneal shunt surgery. The changes of the ONSD between supine and upright positions were calculated as ∆ONSD = sONSD-uONSD and as the variation ONSD_V = 100% × [(sONSD - uONSD)/sONSD]. Multiple linear regression analyses were conducted to assess associations between EI and the variation of ONSD. We derived the mathematical function to predict EI. Bland-Altman analysis was applied to evaluate the accuracy and precision of the EI prediction.
Thirteen adult patients (mean age 61.8 ± 11.1 (SD) years; 6 (46%) female) undergone VP shunt implantation for NPH. The mean EI was 0.432 (95% CI, 0.393-0.471) preoperatively and 0.419 (95% CI, 0.373-0.466) postoperatively (p = 0.066). There is a decrease of the ONSD during positional changes from supine to upright position and pre- and postoperative EI correlated with preoperative variation ONSD_V1 (r = - 0.610 and - 0.648, p < 0.05). The mathematical function for preoperative EI estimation was EI = 0.504 - 0.022 × ONSD_V1 + 0.101 × gender (M = 0; W = 1), (Durbin-Watson value = 1.94), and for postoperative was EI = 0.487 - 0.022 × ONSD_V1 + 0.117 × gender; (Durbin-Watson value 2.23).
Ultrasonographic ONSD measurements in supine and upright position provide a potential method to quantify EI that can be conducted at the bedside.
我们旨在通过测量正常压力脑积水（NPH）患者仰卧位和直立位视神经鞘直径（ONSD），定量评估 Evans 指数（EI）。
在脑室腹腔分流术前后，分别测量仰卧位和直立位的 ONSD。通过计算仰卧位和直立位之间 ONSD 的变化量（ΔONSD=sONSD-uONSD）和 ONSD 变化率（ONSD_V=100%×[(sONSD-uONSD)/sONSD]）来评估 ONSD 的变化。采用多元线性回归分析评估 EI 与 ONSD 变化之间的相关性。我们推导出预测 EI 的数学函数。采用 Bland-Altman 分析评估 EI 预测的准确性和精密度。
13 例成人患者（平均年龄 61.8±11.1（SD）岁；6 例（46%）女性）因 NPH 行 VP 分流植入术。术前 EI 平均值为 0.432（95%CI，0.393-0.471），术后为 0.419（95%CI，0.373-0.466）（p=0.066）。从仰卧位变为直立位时，ONSD 会减小，术前 EI 与术前 ONSD_V1 相关（r=-0.610 和-0.648，p<0.05）。术前 EI 估计的数学函数为 EI=0.504-0.022×ONSD_V1+0.101×性别（M=0；W=1），（Durbin-Watson 值=1.94），术后为 EI=0.487-0.022×ONSD_V1+0.117×性别；（Durbin-Watson 值 2.23）。
仰卧位和直立位的超声 ONSD 测量为定量评估 EI 提供了一种潜在的床边方法。
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