Publicação
Optic nerve-sheath diameter cutoff for intracranial hypertension diagnosis : a systematic review and meta-analysis
| Resumo: | Abstract Introduction: Intracranial pressure (ICP) assessment and monitoring is critical in the management of several neurological and neurosurgical scenarios. Invasive techniques of ICP monitoring have serious risks and a non-invasive technique to determine ICP would improve clinical monitoring in these scenarios. The optic nerve-sheath complex is a central nervous system (CNS) structure in the retrobulbar compartment of the orbit, continuous with the subarachnoid fluid space. Therefore, changes in the CNS fluid space secondary to raised ICP lead to changes in the fluid content inside the optic nerve-sheath complex and to an increase in the optic nerve-sheath diameter (ONSD). However, information is lacking about the normal ONSD and its variation in raised ICP scenarios; a cutoff that could be used to accurately diagnose raised ICP is also missing. This review aimed to estimate the difference in ONSD between individuals with raised ICP and normal ICP, as well as to determine the ONSD cutoff value for diagnosis of raised ICP. Methods: We searched 3 databases (MEDLINE, EMBASE and CENTRAL) for longitudinal observational studies that reported ultrasound measurements of the ONSD in patients with suspected increased ICP subjected to invasive ICP monitoring. QUADAS-2 was used to assess the risk of bias and applicability concerns of each study. Data from the selected studies was then extracted and a meta-analysis was performed. Results: Twenty-four studies including 1512 individuals were reviewed. Twenty-two of these studies provided an ONSD cutoff value for raised ICP diagnosis, and were used to calculate an optimal ONSD cutoff, obtaining a value of 5,42 mm. Fourteen studies provided full data about individuals with and without raised ICP, allowing us to compare their ONSD measurements, which were consistently bigger in the raised ICP group, with the magnitude of the effect corresponding to an ONSD approximately 2,64 mm (95% CI 2,02 – 3,26) larger in patients with raised ICP compared to those without raised ICP. Conclusions: The ideal ONSD cutoff value for raised ICP diagnosis was 5,42 mm. Further studies should be performed using this cutoff to validate it and determine its accuracy in prospective assessment in the diagnosis of raised ICP. As in previous studies, there is a significant difference in the ONSD value of individuals with and without raised ICP. |
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| Autores principais: | Nascimento, Tiago Alexandre Barbosa do |
| Assunto: | Diâmetro da bainha do nervo ótico Ecografia Hipertensão intracraniana Pressão intracraniana |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Abstract Introduction: Intracranial pressure (ICP) assessment and monitoring is critical in the management of several neurological and neurosurgical scenarios. Invasive techniques of ICP monitoring have serious risks and a non-invasive technique to determine ICP would improve clinical monitoring in these scenarios. The optic nerve-sheath complex is a central nervous system (CNS) structure in the retrobulbar compartment of the orbit, continuous with the subarachnoid fluid space. Therefore, changes in the CNS fluid space secondary to raised ICP lead to changes in the fluid content inside the optic nerve-sheath complex and to an increase in the optic nerve-sheath diameter (ONSD). However, information is lacking about the normal ONSD and its variation in raised ICP scenarios; a cutoff that could be used to accurately diagnose raised ICP is also missing. This review aimed to estimate the difference in ONSD between individuals with raised ICP and normal ICP, as well as to determine the ONSD cutoff value for diagnosis of raised ICP. Methods: We searched 3 databases (MEDLINE, EMBASE and CENTRAL) for longitudinal observational studies that reported ultrasound measurements of the ONSD in patients with suspected increased ICP subjected to invasive ICP monitoring. QUADAS-2 was used to assess the risk of bias and applicability concerns of each study. Data from the selected studies was then extracted and a meta-analysis was performed. Results: Twenty-four studies including 1512 individuals were reviewed. Twenty-two of these studies provided an ONSD cutoff value for raised ICP diagnosis, and were used to calculate an optimal ONSD cutoff, obtaining a value of 5,42 mm. Fourteen studies provided full data about individuals with and without raised ICP, allowing us to compare their ONSD measurements, which were consistently bigger in the raised ICP group, with the magnitude of the effect corresponding to an ONSD approximately 2,64 mm (95% CI 2,02 – 3,26) larger in patients with raised ICP compared to those without raised ICP. Conclusions: The ideal ONSD cutoff value for raised ICP diagnosis was 5,42 mm. Further studies should be performed using this cutoff to validate it and determine its accuracy in prospective assessment in the diagnosis of raised ICP. As in previous studies, there is a significant difference in the ONSD value of individuals with and without raised ICP. |
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