From the Departments of Anaesthesiology and İntensive Care (Çevikkalp, Efe,), Departments Of Spine Surgery (Aygün), Bursa Private Medicana Hospital, and from the Departments Of Orthopedics and Traumatology (Yıldız), Bursa Private Atakent Hospital, Bursa, Turkey.
Neurosciences (Riyadh). 2024 Oct;29(4):239-245. doi: 10.17712/nsj.2024.4.20230123.
To evaluate the changes in optic nerve sheath diameter (ONSD) caused by this pressure applied to the dura mater and postoperative complications.
The study was conducted between 01.01.2022 and 01.06.2022 at Private Medicabil Hospital. The ONSD was measured 3 mm behind the eyeball using US at 5 time points: T1 (in the supine position after anesthesia induction), T2 (after conversion to the prone position), T3 (in the prone position after applying pressure to the dura mater), T4 (in the prone position after the discontinuation of applying pressure to the dura mater), T5 (after conversion to the supine position). Postoperative complications were recorded.
The ONSD at T3 was higher than those at all time points. For an ONSD value >5.3 mm, the sensitivity, specificity, positive predictive, and negative predictive values were 87.5%, 71.9%, 50.9%, and 94.5%, respectively (Area under the curve 0.830, 95% Confidence Interval: 0.761-0.899, <0.001) CONCLUSION: We think that the hydrostatic pressure applied to the dura mater in unilateral biportal endoscopic (UBE) surgeries causes changes in the ONSD sheath diameter and that monitoring ONSD with peroperative USG can reduce the possible complications in order to reduce the effects of this pressure on the central nervous system.
评估硬脑膜受压后视神经鞘直径（ONSD）的变化及术后并发症。
本研究于 2022 年 1 月 1 日至 2022 年 6 月 1 日在私立 Medicabil 医院进行。使用超声在眼球后 3mm 处测量 ONSD，共 5 个时间点：T1（麻醉诱导后仰卧位）、T2（改为俯卧位后）、T3（硬脑膜施加压力后俯卧位）、T4（硬脑膜停止施加压力后俯卧位）、T5（改为仰卧位后）。记录术后并发症。
T3 时的 ONSD 高于其他各时间点。对于 ONSD 值>5.3mm，灵敏度、特异度、阳性预测值和阴性预测值分别为 87.5%、71.9%、50.9%和 94.5%（曲线下面积 0.830，95%置信区间：0.761-0.899，<0.001）。
我们认为单侧双通道内镜（UBE）手术中硬脑膜的静水压力会导致 ONSD 鞘直径发生变化，并且通过术中 USG 监测 ONSD 可以减少可能的并发症，以降低这种压力对中枢神经系统的影响。
