Document Detail

Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model.
MedLine Citation:
PMID:  21527613     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study investigated whether it is feasible to use sonography to monitor changes in the optic nerve sheath diameter in a porcine model.
METHODS: A fiber-optic intracranial pressure transducer was surgically placed through the frontal sinus directly into the brain parenchyma of adult Yorkshire pigs (n = 5). A second bolt was placed on the contralateral side for intraparenchymal fluid infusion. Optic nerve sheath diameter measurements were acquired by each of 2 ultrasound operators around the leading edge of the nerve, 3 to 5 mm distal from the origin of the optic nerve. To induce a change in diameter, intracranial pressure was manipulated by injecting normal saline into the intraparenchymal infusion catheter located in the symmetric contralateral position as the pressure-monitoring probe.
RESULTS: Data from 1 pig were unusable because of a cerebrospinal fluid leak into the sinus and orbital fissure. Saline aliquots of 1 to 10 mL were able to generate intracranial pressures typically starting from 10 to 15 mm Hg and increasing to 75 to 90 mm Hg, which eventually evoked a Cushing response. Fluid injection was controlled to increase pressures by 60 mm Hg over a 15- to 20-minute period. Regression analysis of all animals showed that the optic nerve sheath diameter increased by 0.0034 mm/mm Hg of intracranial pressure; however, this slope ranged from 0.0025 to 0.0046, depending on the animal measured. There was no discernible effect of the ultrasound operator on the slope; however, measurements made by 1 operator were consistently higher than the others by about 8% of the overall diameter range.
CONCLUSIONS: These results suggest that the use of the optic nerve sheath diameter to noninvasively confirm acute changes in intracranial pressure over 1 hour is feasible in a porcine model. We recommend that this method be validated in humans using direct intracranial pressure measurement where possible to confirm it as a screening tool for acute and chronically increased diameters secondary to elevated pressure in clinical settings.
Douglas R Hamilton; Ashot E Sargsyan; Shannon L Melton; Kathleen M Garcia; Bill Oddo; David S Kwon; Alan H Feiveson; Scott A Dulchavsky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine     Volume:  30     ISSN:  1550-9613     ISO Abbreviation:  J Ultrasound Med     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-29     Completed Date:  2011-09-26     Revised Date:  2012-02-07    
Medline Journal Info:
Nlm Unique ID:  8211547     Medline TA:  J Ultrasound Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  651-9     Citation Subset:  IM    
Wyle Laboratories/ National Aeronautics and Space Administration, Houston, TX 77058, USA.
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MeSH Terms
Disease Models, Animal*
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Intracranial Hypertension / physiopathology,  ultrasonography*
Intracranial Pressure*
Optic Nerve / ultrasonography*
Reproducibility of Results
Sensitivity and Specificity
Ultrasonography / methods
Comment In:
J Ultrasound Med. 2012 Jan;31(1):130-1   [PMID:  22215781 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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