TRANSORBITAL ULTRASOUND MEASUREMENT OF OPTIC NERVE SHEATH DIAMETER. A NOVEL TECHNIQUE FOR MEASURING INTRA - CRANIAL PRESSURE IN A NEUROSURGICAL INTENSIVE CARE SETUP.

Dr. Sri Krishna Majhi, Rahul Ahluwalia, Dr. Aditya Mantri, Dr. Subhasis Ghosh

Abstract


Observations & Results: In this study 60 patients were enrolled. Mean age of cohort was 40.18 years, with a sex ratio of
1: 1.22 (Male: Female). Mazean pre-operative ONSD
value for right eye was 4.82 mm and post-operative ONSD value for right eye was 4.13 mm. Mean pre-operative ONSD value for left eye was
4.86mm and post-operative value was also 4.13mm. Intra class correlation coefficient was > 0.7 for both eyes during pre-as well as post-operative
studies suggesting a strong Intra – observer agreement. Mean time taken per patient was 11.48 minutes pre-operatively and 11.67 minutes postoperatively.
Conclusion: This study illustrates the feasibility of non-invasive transorbital ultrasound for assessing optic nerve sheath diameter (ONSD) and
to use it for the monitoring of patients in neurology intensive care units for the assessment of raised ICP as a noninvasive tool. The mean value
pre-operatively is 4.84mm and suggests raised ICP. Results demonstrate a significant difference between ONSD of patients before and after
neurosurgical procedure, and thus support the suggested hypothesis of a relationship between deformability of the ONS and ICP. ONSD
measurement on ultrasound yields consistent and acceptable intra - observer variability and repeatability. Further validation of this technique in
prospective, blinded studies would be helpful.
Response to Reviewers: Authors feel that review of literature is adequate for the concerned topic due to its very
wide implications. Advised changes have been made and appropriate references have been mentioned and highlighted.


Keywords


Raised ICP; intra cranial pressure; optic nerve, papilledema

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