Benhur Allan, Sharma Jaiprakash, Karna Sunaina Tejpal, Shrivastava Adesh, Saigal Saurabh, Waindeskar Vaishali Vasant
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
J Neurosci Rural Pract. 2022 Oct-Dec;13(4):676-683. doi: 10.25259/JNRP-2022-3-37. Epub 2022 Dec 2.
Intracranial pressure (ICP) monitoring in patients with intracranial tumors undergoing craniotomy is usually done in perioperative period in intensive care unit. Invasive measurement of ICP, though considered as the gold standard, has its own limitations such as availability of expertise, equipment, and associated complications. Period of raised ICP in post-operative period may impact patient outcomes. Post-craniotomy computed tomography (CT) assessment is done routinely and may need to be repeated if indicated during post-operative stay. Utility of sonographic serial optic nerve sheath diameter (ONSD) assessment in post-operative monitoring of patients who have undergone elective craniotomy was explored in this study. The primary objective of the study was to measure the dynamic change in ONSD as compared to baseline pre-operative measurement in the first 3 postoperative days after elective craniotomy. The secondary objective of the study was to evaluate correlation between ONSD value with Glasgow Coma Scale (GCS) and post-operative CT findings.
In this prospective, observational, and cohort study, we studied adult patients undergoing craniotomy for intracranial tumors. GCS assessment and sonographic measurement of ONSD were done preoperatively, immediate post-operative period, and 12, 24, and 48 h after surgery. CT scan to detect raised ICP was done at 24 h post-operative. Correlation of ONSD with GCS at respective period and correlation of CT scan finding with respective ONSD assessment were evaluated.
A total of 57 patients underwent elective craniotomy for intracranial tumors. Significant difference was observed in ONSD value depending on time of measurement perioperatively (χ = 78.9, = 0.00). There was initial increase in the first 12 h followed by decrease in ONSD in the next 48 h. Negative correlation was observed between baseline ONSD and 12 h GCS (ρ = -0.345, = 0.013). There was significant change in GCS scores based on the status of ONSD (raised or normal) at 12 h after surgery ( = 0.014). Significant correlation between USG ONSD and CT ONSD was observed (ρ = 0.928, = 0.000). Optimal cutoff value of ONSD to detect raised ICP with reference to CT signs was 4.8 mm with 80% sensitivity and 95% specificity.
ONSD undergoes dynamic changes, correlates with CT scan, and has good diagnostic accuracy to detect raised ICP post-craniotomy for intracranial tumors. It may serve as a useful tool in monitoring in resource-limited setup.
接受开颅手术的颅内肿瘤患者的颅内压（ICP）监测通常在重症监护病房的围手术期进行。尽管有创ICP测量被视为金标准，但它有自身的局限性，如专业知识、设备的可用性以及相关并发症。术后ICP升高的时期可能会影响患者的预后。开颅术后计算机断层扫描（CT）评估是常规进行的，如果术后住院期间有指征可能需要重复进行。本研究探讨了超声连续测量视神经鞘直径（ONSD）在择期开颅术后患者监测中的应用。该研究的主要目的是测量择期开颅术后前3天与术前基线测量相比ONSD的动态变化。该研究的次要目的是评估ONSD值与格拉斯哥昏迷量表（GCS）及术后CT结果之间的相关性。
在这项前瞻性、观察性队列研究中，我们研究了接受颅内肿瘤开颅手术的成年患者。术前、术后即刻以及术后12、24和48小时进行GCS评估和ONSD的超声测量。术后24小时进行CT扫描以检测ICP升高情况。评估了各时期ONSD与GCS的相关性以及CT扫描结果与相应ONSD评估的相关性。
共有57例患者接受了颅内肿瘤的择期开颅手术。根据围手术期测量时间的不同，ONSD值存在显著差异（χ = 78.9，P = 0.00）。最初在12小时内升高，随后在接下来的48小时内ONSD下降。术前基线ONSD与术后12小时GCS呈负相关（ρ = -0.345，P = 0.013）。术后12小时，根据ONSD状态（升高或正常），GCS评分有显著变化（P = 0.014）。观察到超声ONSD与CT ONSD之间存在显著相关性（ρ = 0.928，P = 0.000）。参照CT征象检测ICP升高时，ONSD的最佳截断值为4.8mm，灵敏度为80%，特异度为95%。
ONSD会发生动态变化，与CT扫描相关，对检测颅内肿瘤开颅术后ICP升高具有良好的诊断准确性。在资源有限的情况下，它可能是一种有用的监测工具。
