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Abreu Pérez D, Lacerda Gallardo AJ, Gálvez JA. "Roberto Rodríguez" General Teaching Hospital of Moron, Ciego De Avila, Cuba, Neurosurgery and Pediatric Intensive Care Services Pediatric Neuromonitoring in Severe Head Trauma. Neurotrauma Rep 2024; 5:497-511. [PMID: 39036431 PMCID: PMC11257106 DOI: 10.1089/neur.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Among all types of trauma in children, traumatic brain injury has the greatest potential for the development of devastating consequences, with nearly three million affected each year in the world. A controlled, nonrandomized experimental study was carried out in pediatric patients with severe traumatic brain injury, whose objective was to evaluate the use of continuous multimodal neuromonitoring (MMN) of intracranial parameters as a guide in the treatment of children of different age-groups. The patients were divided into two groups according to the treatment received; clinical and imaging monitoring was performed in both. Group I included those whose treatment was guided by MMN of intracranial parameters such as intracranial pressure, cerebral perfusion pressure, and intracranial compliance, and group II included those who had only clinical and imaging monitoring. Eighty patients were studied, 41 in group I and 39 in group II. There were no significant differences between the groups with respect to the sociodemographic variables and the results; as a consequence, both forms of treatment were outlined, for patients with MMN and for those who only have clinical and imaging monitoring. It is concluded that both treatment schemes can be used depending on technological availability, although the scheme with MMN is optimal.
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Affiliation(s)
- Daysi Abreu Pérez
- Department of Pediatric Intensive Care Unit, “Roberto Rodríguez Fernández” General Teaching Hospital of Morón, Ciego de Ávila, Cuba
| | - Angel J. Lacerda Gallardo
- Department of Neurosurgery, “Roberto Rodríguez Fernández” General Teaching Hospital of Morón, Ciego de Ávila, Cuba
| | - Jose Antonio Gálvez
- Department of Neurosurgery, General Teaching Hospital of Morón, Ciego de Ávila, Cuba
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Zhang Y, Cao K, Pang R, Wang N, Qu X, Kang J, Wang N, Liu H. Non-invasive intracranial pressure estimation using ultrasonographic measurement of area of optic nerve subarachnoid space. Br J Ophthalmol 2023; 107:1716-1721. [PMID: 36002239 DOI: 10.1136/bjo-2022-321065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To verify whether the area of the ONSAS (ONSASA) obtained by transorbital ultrasonography can be used to accurately evaluate the intracranial pressure (ICP). METHODS The recorded indexes included the optic nerve diameter, the optic nerve sheath diameter (ONSD), the width of both sides of the ONSAS (ONSASW) at 3 mm from the optic nerve head and the entire ONSASA outlined between 3 and 7 mm. After exploring and comparing five models to describe the relationship between body mass index (BMI), mean arterial blood pressure (MABP), ONSASA and ICP, the best model was determined. RESULTS In all, 90 patients with neurological diseases undergoing continuous invasive ICP monitoring were included in the study. In the training group, the correlation coefficient for the association between the ICP and ONSASA (Pearson's correlation r=0.953) was higher than that for the association of the ICP with the ONSD (r=0.672; p<0.0001) and ONSASW at 3 mm behind the globe (r=0.691; p<0.0001). In the training group, the weighting function for prediction of the ICP was as follows: non-invasive ICP=2.050×ONSASA-0.051×BMI +0.036*MABP-5.837. With 20 mm Hg as the cut-off point for a high or low ICP, the sensitivity and specificity of ONSASA predicting ICP was 1.00 and 0.92. Receiver operator curve analysis revealed that the calculated cut-off value for predicting elevated ICP was 19.96 (area under curve= 0.960, 95% CI 0.865 to 1.00). CONCLUSION Measurement of the ONSASA using ultrasonography can serve as a practical method for rapid and non-invasive quantification for evaluating ICP through an accurate mathematical formula with the BMI and MABP considered as contributing parameters. TRIAL REGISTRATION NUMBER The study was registered in the Chinese Clinical Trial Registry (Study no ChiCTR2100045274).
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Affiliation(s)
- Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Pang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ning Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xin Qu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
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Krueger EM, Benveniste RJ, Taylor RR, Shah S, Moll J, Figueroa JM, Jagid JR. Neurologic Outcomes for Octogenarians Undergoing Emergent Surgery for Traumatic Acute Subdural Hematoma. World Neurosurg 2023; 171:e404-e411. [PMID: 36521754 DOI: 10.1016/j.wneu.2022.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Determining the appropriate surgical indications for obtunded octogenarians with traumatic acute subdural hematoma (aSDH) has been challenging. We sought to determine which easily available data would be useful adjuncts to assist in early and quick decision-making. METHODS We performed a single-center, retrospective review of patients aged ≥80 years with confirmed traumatic aSDH who had undergone emergent surgery. The clinical measurements included the Karnofsky performance scale score, Charlson comorbidity index, Glasgow coma scale (GCS), and abbreviated injury score. The radiographic measurements included the Rotterdam computed tomography score, aSDH thickness, midline shift, and optic nerve sheath diameter (ONSD). The neurologic outcomes were defined using the extended Glasgow outcome scale-extended (GOS-E) at hospital discharge and 3-month follow-up. The Pearson correlation coefficient was used to compare the ONSD with all clinical, radiographic, and outcome variables. Multivariate logistic regression was used to assess the relationship between the discharge and 3-month GOS-E scores between all clinical and radiographic variables. RESULTS A total of 17 patients met the inclusion criteria. The mean age was 82.5 ± 1.6 years (range, 80-85 years), and the mean GCS score was 11.2 ± 4.1 (range, 4-15). The mean discharge and 3-month GOS-E scores were 3.4 ± 2.6 (range, 1-8) and 2.3 ± 2.1 (range, 1-7), respectively. We found significant negative correlations between the ONSD and the GCS score (r = -0.62; P < 0.01) and the ONSD and discharge GOS-E score (r = -0.49; P = 0.05). Multivariate analysis revealed a significant association between the abbreviated injury score and the discharge GOS-E score (P = 0.05). CONCLUSIONS Octogenarians sustaining aSDH and requiring emergent surgery have poor outcomes. More data are needed to determine whether the ONSD can be a useful adjunct tool to predict the efficacy of emergent surgery.
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Affiliation(s)
- Evan M Krueger
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ronald J Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruby R Taylor
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Sumedh Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Moll
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Javier M Figueroa
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Guo Y, Chen Y, Shen C, Fan D, Hu X, Duan J, Chen Y. Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke. Front Neurol 2022; 13:998389. [PMID: 36158954 PMCID: PMC9493305 DOI: 10.3389/fneur.2022.998389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background The optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio has been suggested in the evaluation of intracranial pressure (ICP). The aim of this study was to evaluate the predictive value of ONSD and ONSD/ETD in relation to risk for secondary malignant middle cerebral artery infarction (MMI). Methods A total of 91 patients with MCA occlusion were included in this study. Data were divided into two groups based on development of MMI or not. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratios between the MMI and non-MMI groups were compared. Receiver operating characteristic curve analyses were used to test the diagnostic value of ONSD and ONSD/ETD independently, to predict MMI. Results The ONSD in the MMI group and non-MMI group were 5.744 ± 0.140 mm and 5.443 ± 0.315 mm, respectively (P = 0.001). In addition, the ONSD/ETD ratios in the MMI group and non-MMI group were 0.258 ± 0.008 and 0.245 ± 0.006, respectively (P = 0.001). The receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) for ONSD of 0.812 [95% confidence interval (CI): 0.718–0.906, P = 0.001], with a sensitivity of 97.4% and a specificity of 66.0% at the cut-off value of 5.520 mm. The AUC for ONSD/ETD ratio in predicting occurrence of MMI was 0.895 (95% CI: 0.823–0.968, P = 0.001), with a sensitivity of 84.2% and a specificity of 92.5% at a cut-off value of 0.250. Conclusion In acute stroke patients with massive cerebral infarction, an increased ONSD or ONSD/ETD ratio increases the odds of malignant progression and may be used as an indicator for emergent therapeutic interventions. In addition, the ONSD/ETD ratio may be more valuable than ONSD in predicting the malignant progression of acute stroke patients.
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Determination of ventriculoperitoneal shunt dysfunction using optic nerve sheath diameter measurement on CT scan in pediatric patients with hydrocephalus. Childs Nerv Syst 2021; 37:1895-1900. [PMID: 33694128 DOI: 10.1007/s00381-021-05097-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to evaluate whether optic nerve sheath diameter (ONSD) measurement by computed tomography (CT) can be a diagnostic criteria for the detection of ventriculoperitoneal shunt dysfunction among children whose fontanels are still open. METHODS Patients with a ventriculoperitoneal shunt who were currently showing clinical and radiological signs of acute hydrocephalus depending on the shunt dysfunction were included in this study. The study was designed to compare the preoperative and postoperative ONSDs of three groups of patients divided according to their ages: group 1, patients aged < 4 months; group 2, patients aged 4-18 months; and group 3, patients aged > 18 months. RESULTS We included 138 patients (mean age, 35.18 ± 51.01 months). Among the patients, 46.4% were females and 53.6% were males. ONSD measurements in the preoperative period were < 2.86 ± 0.59 in group 1, 3.93 ± 0.82 in group 2, and 5.40 ± 0.81 in group 3 and those in the postoperative period were 2.02 ± 0.38 in group 1, 2.72 ± 0.62 in group 2, and 3.64 ± 0.81 in group 3. Right, left, and mean ONSDs increased significantly in the three groups and were found to be statistically significant. CONCLUSION ONSD measurement in CT has been evaluated as an appropriate finding that can be used especially in acute hydrocephalus, when clinical and radiological findings are not diagnostic.
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Bardakci O, Das M, Beyazit Y. Letter to the Editor Regarding "Optic Nerve Sheath Measurements by Computed Tomography to Predict Intracranial Pressure and Guide Surgery in Patients with Traumatic Brain Injury". World Neurosurg 2020; 140:421. [PMID: 32797953 DOI: 10.1016/j.wneu.2020.04.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Okan Bardakci
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Murat Das
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yavuz Beyazit
- Department of Internal Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
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Vitiello L, De Bernardo M, Marotta G, Rosa N. Letter to the Editor Regarding "Optic Nerve Sheath Measurements by Computed Tomography to Predict Intracranial Pressure and Guide Surgery in Patients with Traumatic Brain Injury". World Neurosurg 2020; 136:416-417. [PMID: 32204274 DOI: 10.1016/j.wneu.2019.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Livio Vitiello
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Maddalena De Bernardo
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
| | - Giuseppe Marotta
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Nicola Rosa
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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