Index ONSD/ETD (optic nerve sheath diameter/ eyeball transvers diameter) in the diagnostics and prediction of intracranial hypertension (ICH) in patients with cerebral edema

A significant amount of research devoted to the study of the correlation between intracranial hypertension (ICH) and changes in the optic nerve sheaths diameter (ONSD) made it possible to establish, on the one hand, possibility of using ONSD for diagnostic and prognostic purposes, and on the other hand, to identify number of limitations of this technique, such as variability of ONSD due to individual anatomical features of the structure of the eyeball and optic nerve. In connection with this observation, it is advisable to introduce parameter ONSD index — the ratio of the optic nerve sheath diameter to the eyeball diameter, which allows decrease the significance of individual differences.

MATERIALS AND METHODS: on the basis of the. Burdenko Neurosurgery Institute for the period from 2020 to 2021, a prospective single-center observational applied study was conducted, which included 21 patients (5 women and 16 men) with invasive ICP monitoring, of which 17 patients with severe (GCS<8 points) traumatic brain injury (TBI) and 4 patients after aneurysmal subarachnoid haemorrhage (aSAh) (hunt-hess 3–4). The evaluation of the ONSD index was carried out on the basis of the data of the incoming and repeated brain CT, performed with slices up to 1.25 mm thick, and was calculated as the ratio of the ONSD to the transverse eyeball diameter.><points) traumatic brain injury (TBI) and 4 patients after aneurysmal subarachnoid haemorrhage (ASAH) (hunt-hess 3–4). The evaluation of the ONSD index was carried out on the basis of the data of the incoming and repeated brain CT, performed with slices up to 1.25 mm thick, and was calculated as the ratio of the ONSD to the transverse eyeball diameter.

RESULTS. Evaluation of the obtained data using ROC analysis revealed the correlation between the increase in ICP (>20 mm hg) and the increase in the ONSD index and the indicators of the average ICP and median ICP for the first day of monitoring. There was also a correlation between the ONSD index and the maximum values of ICP for the first 48 hours of monitoring.

CONCLUSION. The results obtained reliably confirm the possibility of using the ONSD index parameter for prognostic and diagnostic purposes in patients with ICH syndrome.

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