Decompressive Craniotomy and Craniectomy for Brain Trauma

Optic Nerve Sheath Measurements by Computed Tomography to Predict Intracranial Pressure and Guide Surgery in Patients with Traumatic Brain Injury

BACKGROUND

Research has shown that the optic nerve sheath diameter (ONSD) is a good predictor of intracranial pressure (ICP) and may predict the need for surgery in patients with head injury. The objective was to test the value of ONSD in predicting the requirement for surgery in patients with traumatic brain injury (TBI).

METHODS

In this retrospective cohort study, we first verified the correlation between ICP and ONSD using data from 62 patients with TBI who had undergone ICP monitoring. Second, we analyzed head computed tomography images from patients with TBI who were admitted to the emergency department where patients had been divided into surgery or conservative treatment groups, dependent on the assessment of a neurosurgeon. The correlation between ICP and ONSD was measured using linear regression analysis. Biologistic and receiver operating characteristic curve analyses were used to test the diagnostic value of ONSD to predict surgery.

RESULTS

ONSD was significantly correlated with ICP (r = 0.606; P < 0.01), and there was a significant linear regression equation (ŷ = 0.071 × ICP + 3.533; P < 0.01), with ONSD predicting the requirement for surgery in patients with TBI (area under the curve, 0.920; P < 0.01; 95% confidence interval, 0.877-0.962).

CONCLUSIONS

ONSD measured via head computed tomography correlates with ICP and can predict the requirement for surgery in patients with TBI following admission to the emergency department.