Sharma Archana, Oak Shrikanta, Devani Kavin, Sawant Siddhi, Manisha C, Sharma Akshita
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Anesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Indian J Anaesth. 2025 Sep;69(9):940-948. doi: 10.4103/ija.ija_871_24. Epub 2025 Aug 12.
Ultrasonographic (USG) optic nerve sheath diameter (ONSD) provides a real-time, non-invasive method for assessing intracranial pressure. This study investigates perioperative ONSD variations and contributing factors in patients undergoing elective intracranial tumour resection.
A prospective observational study was conducted on 94 adults with intracranial tumours, excluding orbital lesions and sellar/suprasellar tumours. Preoperative symptoms, Glasgow coma scale scores, and radiological findings were noted. USG-ONSD was assessed in the transverse and sagittal plane on each eye, with an average of three readings at the following time-points: pre-induction, post-induction, post-extubation, and 24-hour post-tumour resection. The presence of ventriculo-peritoneal (VP) shunt, duration of surgery/anaesthesia, intraoperative position, use of osmotic agents, and complications during surgery were noted. The data were analysed using linear regression and general linear modelling in R software.
ONSD increased significantly ( = 0.001) immediately after surgery and decreased 24 hours after surgery ( < 0.001) compared to preoperative values. Although the trend of ONSD changes was similar for both supratentorial and infratentorial tumours, supratentorial tumours consistently showed higher values ( = 0.549). Higher American Society of Anesthesiologists physical status, nausea/vomiting, visual field affection, midline shift, mass effect, and larger tumour size were associated with higher preoperative values. Similarly, large-size tumours ( < 0.001), shorter duration of symptoms ( = 0.001), and lateral intraoperative positioning ( = 0.028) showed significantly higher values and greater changes, whereas the presence of VP shunt, use of osmotherapy, and sitting position for surgery showed a lower trend of ONSD postoperatively.
USG-ONSD demonstrates dynamic changes in patients undergoing intracranial tumour resection. ONSD is affected by the size of the tumour, duration of symptoms, and intraoperative positioning, though the trend is homogenous among supratentorial and infratentorial tumours.
超声（USG）测量的视神经鞘直径（ONSD）为评估颅内压提供了一种实时、非侵入性的方法。本研究调查择期颅内肿瘤切除术患者围手术期ONSD的变化及其影响因素。
对94例颅内肿瘤成人患者进行前瞻性观察研究，排除眼眶病变和鞍区/鞍上区肿瘤。记录术前症状、格拉斯哥昏迷量表评分和影像学检查结果。在每只眼睛的横切面和矢状面评估USG-ONSD，在以下时间点平均读取三次数据：诱导前、诱导后、拔管后和肿瘤切除后24小时。记录脑室-腹腔（VP）分流管的存在情况、手术/麻醉持续时间、术中体位、渗透性药物的使用以及手术期间的并发症。使用R软件中的线性回归和一般线性模型对数据进行分析。
与术前值相比，术后ONSD立即显著增加（P = 0.001），术后24小时下降（P < 0.001）。尽管幕上和幕下肿瘤的ONSD变化趋势相似，但幕上肿瘤的值始终较高（P = 0.549）。美国麻醉医师协会身体状况分级较高、恶心/呕吐、视野受累、中线移位、占位效应和肿瘤体积较大与术前值较高相关。同样，大体积肿瘤（P < 0.001）、症状持续时间较短（P = 0.001）和术中侧卧位（P = 0.028）的值显著更高且变化更大，而VP分流管的存在、渗透性治疗的使用和手术坐位术后ONSD呈下降趋势。
USG-ONSD显示颅内肿瘤切除术患者的动态变化。ONSD受肿瘤大小、症状持续时间和术中体位的影响，尽管幕上和幕下肿瘤的趋势是一致的。
