Dynamics of the optic nerve sheaths diameter in patients with severe traumatic brain injury and decompressive craniotomy

INTRODUCTION. Correlation between the optic nerve sheath diameter (ONSD) and the intracranial pressure (ICP) in the acute period of severe traumatic brain injury has been confirmed in numerous publications by foreign and Russian authors. Evaluation of ONSD in patients with cerebral edema and suspected intracranial hypertension (ICH) is possible using neuroimaging (CT, MRI) and ultrasound diagnostic methods (US). The use of ONSD data in patients with severe traumatic brain injury may be of diagnostic and prognostic value in the analysis of therapeutic and surgical methods effectiveness, including decompressive craniectomy (DCT).

AIM. To evaluate changing in the ONSD on computed tomography (CT) in patients with severe traumatic brain injury after decompression craniotomy (DCT).

MATERIALS AND METHODS. For the period from 2020 to 2022 on the basis of the N. N. Burdenko National Medical Research Center of Neurosurgery conducted a prospective single-center observational study included 31 patients (7 women and 24 men) with severe (GCS ≤ 8 points) traumatic brain injury (TBI) and invasive ICP monitoring. The final version of the study included 8 patients (3 women and 5 men) with a wide DCT during the first 3 days after the injury. The mean age in this group was 30 [26.3; 53.0]. All patients underwent invasive ICP monitoring and ICP-oriented therapy according to international and Russian recommendations. Analysis of the ONSD dynamics was carried out based on the comparison of the average, maximum, and minimum values of the ONSD before and after decompression.

RESULTS. Significant differences were found in the ONSD in patients with severe TBI before and after decompressive trepanation: decrease in the maximum ONSD from 7.53 to 6.89 mm and decrease in the minimum ONSD from 7.20 to 6.54 mm (p=0.022 in both cases). These results allow us to conclude that changing in the ONSD parameter is affected by the fact of DCT – significantly lower ONSD values and also stabilization of ICP were noted after DCT in 75 % of the observations.

CONCLUSION. The conductedstudy indicates the relationship between significant decrease in the ONSD parameter and the fact of DCT, accompanied by stabilization of ICP, in patients in the acute period of severe TBI.

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