Monitoring of Intracranial Pressure by CT‐Defined Optic Nerve Sheath Diameter

Bekerman, Inessa; Kimiagar, Itzhak; Tal, Sigal; Vaiman, Michael

doi:10.1111/jon.12322

Cited by 13 publications

(20 citation statements)

References 21 publications

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“…Jiang et al ’s study reviewed optic canal CT images of 100 healthy volunteers using 2.5 mm slice thickness, reconstructed 0.625 mm thickness and showed that the narrowest part of the optic canal tends to be in the middle of the canal 8. Another study using CT images from 300 healthy volunteers found a minimum cross-sectional area of 13.85±2.89 mm 2 with a range of 11 to 16.75 mm 2 , which are similar to our findings 15. Lee et al investigated comparisons of the narrowest cross-sectional area of the optic canal between 38 patients with fibrous dysplasia and 38 healthy controls and found an average area of 11.9±2.8 mm 2 in the control group, also comparable with our findings.…”

Section: Discussionsupporting

confidence: 91%

“…Bekerman et al measured CT scans from 300 volunteers and found that the average minimum diameter at the minimal area of the optic canal is 4.2±1.7 mm for circular lumens and 4.0±1.6 mm for oval lumens,15 which are somewhat larger but still comparable to our average of 3.28±0.55 mm. Jiang et al 8 measured multiple layers through the optic canal and found a minimum diameter of 4.86±0.26 mm on the left and 4.91±0.30 mm on the right which is slightly larger than our measurements, likely as a result of averaging measurements at each set slice rather averaging results at the narrowest portion of each canal.…”

Section: Discussionsupporting

confidence: 81%

“…Establishing a baseline for the narrowest part of the optic canal provides ease of comparison in future studies and provides anatomical information for clinical decision making. For example, Bekerman et al 15 suggests measuring optic canal size concurrently with optic nerve sheath diameter (ONSD) when monitoring ICP and to interpret ONSD cautiously when the optic canal is narrower than 6.6 mm 2 . At this cut-off, 4.8% (16/335) of optic canals would be excluded from ONSD monitoring based on these criteria.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of optic canal anatomy and symmetry using CT

et al. 2019

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ObjectiveWe aim to describe the anatomy and symmetry patterns of the optic canal in patients having undergone maxillofacial CT imaging.MethodsIn this retrospective chart review, we included all patients who received sinus and maxillofacial CT at the University of North Carolina hospitals between 2008 and 2016, without facial or cranial fractures or other medical conditions that would affect optic canal size. We measured the length of ≥75% enclosed canal, minimum cross-sectional area and minimum diameter bilaterally using iNtuition TeraRecon (Durham, North Carolina) and compared bilateral symmetry using a 20 % difference threshold. Each parameter above was compared among white, black, non-white and non-black patients.ResultsOf 335 patients, the mean canal length was 5.61±2.22 mm. The mean minimum area was 11.84±3.11 mm2. The mean minimum diameter was 3.28±0.55 mm. A total of 39.4% (132/335) of patients had asymmetric canal lengths, 18.8% (63/335) had asymmetric minimum areas, and 12.5% (42/335) had asymmetric minimum diameters. No differences were found between racial groups. The right optic canal was larger than the left (right: 12.12 mm vs left: 11.55 mm, p<0.0001).ConclusionOptic canal asymmetry is not uncommon. It may affect risk of papilloedema severity, explain cases of unilateral or asymmetric papilloedema and possibly asymmetric glaucoma.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Evaluation of optic canal anatomy and symmetry using CT

et al. 2019

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“…34 While ONSD has been proven effective in patients with IIH, Bekerman et al noted a potential limitation with the ONSD method in that, cases with narrow optic canal lumen (< 10 mm 2 ) result in false-negative tests and conclude that if the lumen of the canal is < 10 mm 2 , the ONSD method should not be used. 37 It should also be noted that one study found the ONSD method of ICP measurement was unreliable, with sensitivity and specificity values of 36 and 38%, respectively. 35 Despite these findings as well as the fact that invasive ICP measurement via lumbar puncture remains the gold standard, measurement of ONSD has overall demonstrated efficacy and offers an efficient, cost-effective, noninvasive method of diagnosis and monitoring of ICP in patients with IIH.…”

Section: Noninvasive Diagnostics and Monitoring Noninvasive Measuremementioning

confidence: 99%

Noninvasive Monitoring and Neurointerventional Management of Idiopathic Intracranial Hypertension

Lang

Mathew

Harris

et al. 2020

J Clin Interv Radiol ISVIR

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Idiopathic intracranial hypertension (IIH) is characterized by isolated rise in intracranial pressure (ICP) leading to chronic, debilitating headaches, tinnitus, and vision loss. Conventional diagnostics and monitoring primarily require the use of invasive procedure like lumbar puncture to measure ICP, while traditional management strategies involve weight reduction and medical treatment with acetazolamide. In an effort to reduce the need for invasive procedures, noninvasive methods of ICP monitoring such as optic nerve sheath diameter measurements and two-depth transcranial Doppler ultrasonography have been developed. In cases of refractory and fulminant IIH, surgical management strategies such as optic nerve sheath fenestration (ONSF), ventriculoperitoneal (VP) and lumboperitoneal (LP) shunting, and transverse venous sinus stenting are used to relieve symptoms via ICP reduction. While ONSF and VP/LP shunting exhibit utility primarily for the treatment of vision loss and headache, respectively, venous sinus stenting may prove to be an effective option in the management of all symptoms of IIH. Most importantly, consideration of the patient’s individual symptoms and values should be taken into account when choosing the optimal surgical management strategy for patients with IIH.

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“…mm2 as patients with narrow canals had false negative readings, prior to using ONSD to predict ICP may improve the sensitivity of this method 58. In physiological conditions, the relaxed septum pallucidum undulates at higher amplitudes than the surrounding structures.…”

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confidence: 99%

The Monitoring of Brain Edema and Intracranial Hypertension

Hirzallah

Choi

2016

J Neurocrit Care

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Preventing secondary brain injury after neurological insults is one of the primary goals of the neurocritical care unit. Our understanding of the roles of intracranial pressure (ICP) and cerebral edema in managing patients in the neurocritical care units is still evolving. Recent clinical trials examining the monitoring and treatment of elevated ICP have influenced the way we think about intracranial hypertension. Additionally, new methods of monitoring ICP, new physiologic surrogates derived from ICP measurements, and evolving technology to measure cerebral edema are currently being studied and tested for clinical efficacy. In this article, we will discuss both traditional and novel methods of monitoring ICP and cerebral edema.

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Monitoring of Intracranial Pressure by CT‐Defined Optic Nerve Sheath Diameter

Abstract: In its narrowest part, the average OC is 11 to 16.75 mm² wide. We suggest measuring this area simultaneously with the ONSD during ICP monitoring. If the area of the narrowest lumen of the canal is less than 10 mm², ONSD technique for ICP monitoring should not be used.

Cited by 13 publications

References 21 publications

Evaluation of optic canal anatomy and symmetry using CT

Evaluation of optic canal anatomy and symmetry using CT

Noninvasive Monitoring and Neurointerventional Management of Idiopathic Intracranial Hypertension

The Monitoring of Brain Edema and Intracranial Hypertension

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