Optic nerve sheath diameter correlates to intracranial pressure in spontaneous CSF leak patients

Background Spontaneous cerebrospinal fluid (sCSF) leaks develop from pressure erosion due to idiopathic intracranial hypertension, treatment of which is paramount to preventing recurrence. Direct measurements of intracranial pressure (ICP) for monitoring response to treatment via lumbar drain (LD) o...

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Bibliographic Details
Published in:International forum of allergy & rhinology 2023-08, Vol.13 (8), p.1518-1524
Main Authors: Tilak, Ashwini M., Yang, Lydia C., Morgan, Jake, Peña‐Garcia, Jaime, Thompson, Maxwell, Burleson, Samuel, Atkins, Amanda, Sheehan, Delaney, Cho, Do‐Yeon, Woodworth, Bradford A., Grayson, Jessica W.
Format: Article
Language:English
Subjects:
Acetazolamide
Body mass index
Cerebrospinal fluid
CSF leak
CSF leak repair
dilated optic nerve sheath
idiopathic intracranial hypertension
intracranial hypertension
Intracranial pressure
Optic nerve
optic nerve sheath diameter
Patients
skull base repair
spontaneous CSF leak
Ultrasonic imaging
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Summary:Background Spontaneous cerebrospinal fluid (sCSF) leaks develop from pressure erosion due to idiopathic intracranial hypertension, treatment of which is paramount to preventing recurrence. Direct measurements of intracranial pressure (ICP) for monitoring response to treatment via lumbar drain (LD) or ventriculostomy are invasive and have risks. The objectives of this study are to determine whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) correlate with LD ICP in patients with sCSF leaks undergoing treatment, and whether ONSDs are larger in patients with sCSF leaks than controls. Methods Subjects with sCSF leaks and controls were prospectively recruited. ONSD, sex, and body mass index (BMI) were analyzed. For sCSF leak subjects, ultrasonography was performed at the time of LD opening and each pressure check postoperatively, including the acetazolamide response. In control patients, measurements were obtained at the time of surgery. Pearson's correlation between ONSD and ICP was performed. Results Subjects with sCSF leaks (n = 9, age 52.4 ± 9.5, all female) and controls (n = 8, age 60.1 ± 14.8, two females) had significantly different BMIs, 38.4 ± 8.1 vs. 29.2 ± 4.8, t(15) = 2.793, p = 0.014. ONSD was strongly correlated with ICP measurements (r = 0.583, p = 0.002). However, percentage change in ONSD and ICP measurements were more strongly correlated (r = 0.733, p 
ISSN:2042-6976
2042-6984
DOI:10.1002/alr.23120