Salih M S Mohamed, Sethuramachandran Adinarayanan, Bidkar Prasanna Udupi, Dey Ankita, R Gopikrishnan, Gunasekaran Adethen, Chandar Vivek
Department of Neuroanesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Asian J Neurosurg. 2024 Jun 3;19(2):242-249. doi: 10.1055/s-0044-1786701. eCollection 2024 Jun.
Optic nerve sheath diameter (ONSD) measured using ultrasonography has been widely used as a surrogate marker of elevated intracranial pressure. However, literature is sparse on the correlation between ONSD and ventriculoperitoneal (VP) shunt function, especially in adults with hydrocephalus. Our study was designed to assess the correlation between ONSD measured using ultrasonography before and 12 hours after VP shunt placement and the success of VP shunt placement assessed using computed tomography (CT) of the brain. Fifty-one patients between 16 and 60 years of age, with obstructive hydrocephalus scheduled for VP shunt surgery were included in this prospective, observational study. ONSD measurements were obtained from both eyes prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery. An average of three readings was obtained from each eye. Cerebrospinal fluid (CSF) opening pressure was noted after entry into the lateral ventricle. Noncontrast CT (NCCT) brain was obtained 12 hours after the surgery and was interpreted by the same neurosurgeon for signs of successful VP shunt placement. There was a significant reduction in ONSD in the postoperative period compared to ONSD measured preoperatively. The average ONSD (mean ± standard deviation) measured prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery was 5.71 ± 0.95, 5.20 ± 0.84, 5.06 ± 0.79, 4.90 ± 0.79, and 4.76 ± 0.75 mm, respectively. The mean CSF opening pressure was 19.6 ± 6.9 mm Hg. Postoperative NCCT brain revealed misplacement of the shunt tip in only one patient. ONSD measured using ultrasonography may be used as a reliable indicator of VP shunt function in adults with obstructive hydrocephalus.
使用超声测量的视神经鞘直径（ONSD）已被广泛用作颅内压升高的替代指标。然而，关于ONSD与脑室腹腔（VP）分流功能之间相关性的文献较少，尤其是在患有脑积水的成年人中。我们的研究旨在评估VP分流置入术前和术后12小时使用超声测量的ONSD与使用脑部计算机断层扫描（CT）评估的VP分流置入成功率之间的相关性。
本前瞻性观察性研究纳入了51例年龄在16至60岁之间、计划进行VP分流手术的梗阻性脑积水患者。在麻醉诱导前、手术后即刻以及术后6、12和24小时从双眼获取ONSD测量值。每只眼睛平均获取三次读数。进入侧脑室后记录脑脊液（CSF）开放压力。术后12小时进行脑部非增强CT（NCCT）检查，并由同一位神经外科医生解读以判断VP分流置入成功的迹象。
与术前测量的ONSD相比，术后ONSD有显著降低。麻醉诱导前、手术后即刻以及术后6、12和24小时测量的平均ONSD（平均值±标准差）分别为5.71±0.95、5.20±0.84、5.06±0.79、4.90±0.79和4.76±0.75毫米。平均CSF开放压力为19.6±6.9毫米汞柱。术后脑部NCCT显示仅1例患者分流尖端位置不当。
对于患有梗阻性脑积水的成年人，使用超声测量的ONSD可作为VP分流功能的可靠指标。
