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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 242-249
DOI: 10.1055/s-0044-1786701
Research Article

Comparison of Optic Nerve Sheath Diameter (ONSD) Measurements Obtained from USG Before and After Placement of Ventriculoperitoneal Shunt in Obstructive Hydrocephalus as a Surrogate Marker for Adequacy of Shunt Function: A Prospective Observational Study

M. S. Mohamed Salih
1   Department of Neuroanesthesiology, All India Institute of Medical Sciences, New Delhi, India
,
Adinarayanan Sethuramachandran
2   Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Prasanna Udupi Bidkar 
2   Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Ankita Dey 
3   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bathinda, Bathinda, Punjab, India
,
Gopikrishnan R.
4   Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Adethen Gunasekaran
2   Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Vivek Chandar
2   Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract

Introduction 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.

Materials and Methods 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.

Results 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.

Conclusion ONSD measured using ultrasonography may be used as a reliable indicator of VP shunt function in adults with obstructive hydrocephalus.

Keywords

computed tomography scan - hydrocephalus - optic nerve - ultrasonography - ventriculoperitoneal shunt

Authors' Contributions

The concept and design of the review article were developed by P.U.B., A.D., A.S., and S.M. Data acquisition, analysis, and manuscript preparation were carried out by P.U.B., A.G., V.C., and S.M. Critical revision and finalization of the manuscript were conducted by P.U.B., A.D., and A.S.. All authors contributed to the conceptualization and design of the review article. Additionally, all authors have thoroughly reviewed and approved the manuscript, attesting to its integrity and authenticity.




Publication History

Article published online:
03 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rekate HL. A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol 2009; 16 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 2 Isaacs AM, Riva-Cambrin J, Yavin D. et al. Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS One 2018; 13 (10) e0204926
    CrossrefPubMedGoogle Scholar
  • 3 Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 2011; 37 (07) 1059-1068
    CrossrefPubMedGoogle Scholar
  • 4 Chopra A, Das PK, Parashar S. et al. Clinical Relevance of Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter (ONSD) for Estimation of Intracranial Pressure Following Cerebrospinal Fluid Diversion Surgery. Cureus. Accessed July 18, 2022 at: https://www.cureus.com/articles/67294-clinical-relevance-of-transorbital-ultrasonographic-measurement-of-optic-nerve-sheath-diameter-onsd-for-estimation-of-intracranial-pressure-following-cerebrospinal-fluid-diversion-surgery
    Google Scholar
  • 5 Zhang X, Medow JE, Iskandar BJ. et al. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas 2017; 38 (08) R143-R182
    CrossrefPubMedGoogle Scholar
  • 6 Böhm JK, Güting H, Thorn S. et al. Global characterisation of coagulopathy in isolated traumatic brain injury (iTBI): a center-TBI analysis. Neurocrit Care 2021; 35 (01) 184-196
    CrossrefPubMedGoogle Scholar
  • 7 Zhang J, Zhang F, Dong JF. Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury. Blood 2018; 131 (18) 2001-2006
    CrossrefPubMedGoogle Scholar
  • 8 Kalantari H, Jaiswal R, Bruck I. et al. Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med 2013; 31 (11) 1595-1597
    CrossrefPubMedGoogle Scholar
  • 9 Hall MK, Spiro DM, Sabbaj A, Moore CL, Hopkins KL, Meckler GD. Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department. Childs Nerv Syst 2013; 29 (12) 2275-2280
    CrossrefPubMedGoogle Scholar
  • 10 Goeres P, Zeiler FA, Unger B, Karakitsos D, Gillman LM. Ultrasound assessment of optic nerve sheath diameter in healthy volunteers. J Crit Care 2016; 31 (01) 168-171
    CrossrefPubMedGoogle Scholar
  • 11 Bhandari D, Udupi Bidkar P, Adinarayanan S, Narmadhalakshmi K, Srinivasan S. Measurement of changes in optic nerve sheath diameter using ultrasound and computed tomography scan before and after the ventriculoperitoneal shunt surgery in patients with hydrocephalus - a prospective observational trial. Br J Neurosurg 2019; 33 (02) 125-130
    CrossrefPubMedGoogle Scholar
  • 12 Evensen KB, Eide PK. Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement. Fluids Barriers CNS 2020; 17 (01) 34
    CrossrefPubMedGoogle Scholar
  • 13 Bäuerle J, Schuchardt F, Schroeder L, Egger K, Weigel M, Harloff A. Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol 2013; 13: 187
    CrossrefPubMedGoogle Scholar
  • 14 Geeraerts T, Newcombe VF, Coles JP. et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 2008; 12 (05) R114
    CrossrefPubMedGoogle Scholar
  • 15 Ballantyne J, Hollman AS, Hamilton R. et al. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 1999; 54 (11) 740-742
    CrossrefPubMedGoogle Scholar
  • 16 Padayachy LC, Kilborn T, Carrara H, Figaji AA, Fieggen GA. Change in optic nerve sheath diameter as a radiological marker of outcome from endoscopic third ventriculostomy in children. Childs Nerv Syst 2015; 31 (05) 721-728
    CrossrefPubMedGoogle Scholar
  • 17 Padayachy LC, Padayachy V, Galal U, Gray R, Fieggen AG. The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children : part I: repeatability, observer variability and general analysis. Childs Nerv Syst 2016; 32 (10) 1769-1778
    CrossrefPubMedGoogle Scholar
  • 18 Singhal A, Yang MMH, Sargent MA, Cochrane DD. Does optic nerve sheath diameter on MRI decrease with clinically improved pediatric hydrocephalus?. Childs Nerv Syst 2013; 29 (02) 269-274
    CrossrefPubMedGoogle Scholar
  • 19 Lee HC, Lee WJ, Dho YS, Cho WS, Kim YH, Park HP. Optic nerve sheath diameter based on preoperative brain computed tomography and intracranial pressure are positively correlated in adults with hydrocephalus. Clin Neurol Neurosurg 2018; 167: 31-35
    CrossrefPubMedGoogle Scholar
  • 20 Wang J, Li K, Li H. et al Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg 2019; 133 (02) 514-520
    CrossrefPubMedGoogle Scholar
  • 21 Subramanian S, Nair S, Moorthy RK. et al. Utility of serial optic nerve sheath diameter measurements in patients undergoing cerebral spinal fluid diversion procedures for hydrocephalus. World Neurosurg 2021; 154: e168-e175
    CrossrefPubMedGoogle Scholar
  • 22 Khan F, Rehman A, Shamim MS, Bari ME. Factors affecting ventriculoperitoneal shunt survival in adult patients. Surg Neurol Int 2015; 6 (01) 25
    CrossrefPubMedGoogle Scholar
  • 23 Ertl M, Knüppel C, Veitweber M. et al. Normal age- and sex-related values of the optic nerve sheath diameter and its dependency on position and positive end-expiratory pressure. Ultrasound Med Biol 2020; 46 (12) 3279-3285
    CrossrefPubMedGoogle Scholar
  • 24 Schroeder C, Katsanos AH, Richter D, Tsivgoulis G, Gold R, Krogias C. Quantification of optic nerve and sheath diameter by transorbital sonography: a systematic review and metanalysis. J Neuroimaging 2020; 30 (02) 165-174
    CrossrefPubMedGoogle Scholar
  • 25 Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computed tomography: a systematic review and meta-analysis. J Ultrasound Med 2015; 34 (07) 1285-1294
    CrossrefPubMedGoogle Scholar
  • 26 Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: an observational study. Indian J Crit Care Med 2014; 18 (11) 728-734
    CrossrefPubMedGoogle Scholar
  • 27 Gangemi M, Cennamo G, Maiuri F, D'Andrea F. Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987; 30 (02) 53-55
    PubMedGoogle Scholar
  • 28 Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15 (03) 506-515
    CrossrefPubMedGoogle Scholar
  • 29 Thotakura AK, Marabathina NR, Danaboyina AR, Mareddy RR. Role of serial ultrasonic optic nerve sheath diameter monitoring in head injury. Neurochirurgie 2017; 63 (06) 444-448
    CrossrefPubMedGoogle Scholar
  • 30 Kavi T, Gupta A, Hunter K, Schreiber C, Shaikh H, Turtz AR. Optic Nerve Sheath Diameter Assessment in Patients with Intracranial Pressure Monitoring. Cureus. Accessed June 28, 2022 at: https://www.cureus.com/articles/15434-optic-nerve-sheath-diameter-assessment-in-patients-with-intracranial-pressure-monitoring
    Google Scholar
  • 31 Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med 2017; 35 (01) 150-153
    CrossrefPubMedGoogle Scholar
  • 32 Sahu S, Panda N, Swain A. et al. Optic Nerve Sheath Diameter: Correlation With Intra-Ventricular Intracranial Measurements in Predicting Dysfunctional Intracranial Compliance. Cureus. Accessed July 20, 2022 at: https://www.cureus.com/articles/50019-optic-nerve-sheath-diameter-correlation-with-intra-ventricular-intracranial-measurements-in-predicting-dysfunctional-intracranial-compliance
    Google Scholar
  • 33 Choi SH, Min KT, Park EK, Kim MS, Jung JH, Kim H. Ultrasonography of the optic nerve sheath to assess intracranial pressure changes after ventriculo-peritoneal shunt surgery in children with hydrocephalus: a prospective observational study. Anaesthesia 2015; 70 (11) 1268-1273
    CrossrefPubMedGoogle Scholar
  • 34 Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H. The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg 2017; 98: 654-658
    CrossrefPubMedGoogle Scholar
  • 35 Harischandra LS, Sharma A, Chatterjee S. Shunt migration in ventriculoperitoneal shunting: a comprehensive review of literature. Neurol India 2019; 67 (01) 85-99
    CrossrefPubMedGoogle Scholar