Can optic nerve sheath diameter assess increased intracranial pressure in pneumoperitoneum and trendelenburg position?

Abstract

Background: Increased intracranial pressure (ICP) is a serious problem that may potentially cause significant neurological complications. Multiple means of assessment have been used to identify patients with increased ICP. These methods are invasive, sophisticated and timeconsuming, whilst optic nerve sheath diameter (ONSD) by ultrasonography is postulated as a non-invasive, fast and accurate measure to diagnose increased ICP. Patients and methods: A cross-sectional study was performed on 20 ASA physical status I and II female patients undergoing elective gynecological laparoscopic surgeries requiring pneumoperitoneum and Trendelenburg positioning. We investigated the change in ONSD in response to the change in positional change as well as to pneumoperitoneum in order to assess their effect on ICP in laparoscopic surgeries. Results: An analysis of variants comparing values of ONSD at different time points demonstrated that sagittal and transverse ONSD in both right and left eyes were significantly higher at all time points except for the time of assessment, after induction and at 30 min after extubation, all of which were statistically non-significant compared to baseline values. It also showed that, although values of ONSD after induction were non-significantly different from baseline, they rose significantly after insufflation and did not return to baseline until 30 min after extubation. Conclusion: ONSD is an accurate noninvasive modality for the assessment of raised ICP by ocular sonography. We recommend that duration and positioning should be optimized for such prolonged surgery in the Trendelenburg position.

The Impact of Steep Trendelenburg Position on Intraocular Pressure

“…The rise in ICP generated by CO 2 pneumoperitoneum and the TP is related to ONSD. The head-down position, as well as head rotation and/or flexion, increase ICP due to a fluid shift and venous engorgement, as well as a blockage of cerebral venous outflow caused by the increased central venous pressure [ 53 ].…”

“…In recent years, many authors have investigated the role of ONSD increases in identifying how increased IOP in TP affects ICP. Many authors examined the role of Ultrasonographic measurement of ONSD in identifying ICP changes during STP, confirming that ONSD increases in TP with pneumoperitoneum, as STP and pneumoperitoneum have a detrimental effect on cerebral hemodynamic physiology [ 49 , 51 , 52 , 53 ].…”