Predictive Value of Optic Nerve Sheath Diameter in Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.19166/med.v14i1.9240Keywords:
Intracranial pressure, Optic nerve sheath diameter, Subarachnoid hemorrhageAbstract
Introduction : Optic nerve sheath diameter (ONSD) is a promising non-invasive marker for elevated intracranial pressure (ICP), potentially aiding in the prognostication of subarachnoid hemorrhage (SAH) outcomes. This study aimed to evaluate the predictive value of ONSD for poor outcomes in SAH patients, defined by the Glasgow Outcome Scale (GOS).
Methods : A systematic review and meta-analysis were conducted, including studies from 2010 to 2021 that examined the relationship between ONSD and outcomes in SAH patients. A total of 615 patients were analyzed, with mean ages ranging from 54.1 to 58.8 years, and a predominance of males (38.2%). SAH severity was stratified using the Hunt and Hess classification, ranging from Grade 1 to Grade 5. The QUADAS-2 tool assessed the risk of bias, and the GRADE framework evaluated evidence certainty.
Results : The pooled analysis revealed moderate predictive accuracy for ONSD in determining poor outcomes, with a pooled proportion of 0.70 (95% CI: 0.61–0.78). Significant heterogeneity (I² = 77.4%, p = 0.004) was observed, likely due to variability in ONSD thresholds, measurement techniques, and timing. Funnel plot analysis suggested potential publication bias, although further statistical testing is needed.
Conclusions : ONSD demonstrates potential as a non-invasive tool for predicting poor outcomes in SAH patients. However, significant heterogeneity and moderate accuracy highlight the need for standardization of ONSD thresholds and measurement protocols. Further multicenter studies are required to validate its clinical utility and integrate it into comprehensive prognostic models.
References
1. Ziu E, Khan Suheb MZ, Mesfin FB. Subarachnoid Hemorrhage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441958/
2. Nag DS, Sahu S, Swain A, Kant S. Intracranial pressure monitoring: Gold standard and recent innovations. WJCC. 2019 Jul 6;7(13):1535–53. https://doi.org/10.12998/wjcc.v7.i13.1535
3. Xu H, Li Y, Liu J, Chen Z, Chen Q, Xiang Y, et al. Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis. 2022;51(2):199–206. https://doi.org/10.1159/000518724
4. Wang LJ, Chen HX, Tong L, Chen LM, Dong YN, Xing YQ. Ultrasonographic optic nerve sheath diameter monitoring of elevated intracranial pressure: two case reports. Ann Transl Med. 2020 Jan;8(1):20. https://doi.org/10.21037/atm.2019.12.16
5. Lee S, Kim YO, Baek JS, Ryu JA. The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage. Crit Care. 2019 Feb 26;23(1):65. https://doi.org/10.1186/s13054-019-2360-6
6. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011 Oct 18;155(8):529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009
7. Cenik Y, Baydin A, Çakmak E, Fidan M, Aydin K, Tuncel ÖK, et al. The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage. Clin Neurol Neurosurg. 2021 Aug;207:106813. https://doi.org/10.1016/j.clineuro.2021.106813
8. Zhu S, Cheng C, Zhao D, Zhao Y, Liu X, Zhang J. The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions. BMC Neurol. 2021 Jul 2;21(1):259. https://doi.org/10.1186/s12883-021-02285-7
9. Yesilaras M, Kilic TY, Yesilaras S, Atilla OD, Öncel D, Çamlar M. The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage. Am J Emerg Med. 2017 Oct;35(10):1408–13. https://doi.org/10.1016/j.ajem.2017.04.022
10. Kim J, Shin H, Lee H. Association between optic nerve sheath diameter/eyeball transverse diameter ratio and neurological outcomes in patients with aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 2023 Nov;66(6):664–71. https://doi.org/10.3340/jkns.2023.0073
11. Al-Hassani A, Strandvik G, Abayazeed S, Ahmed K, El-Menyar A, Mahmood I, et al. Relationship of optic nerve sheath diameter and intracranial hypertension in patients with traumatic brain injury. J Emerg Trauma Shock. 2020;13(3):183. https://doi.org/10.4103/jets.jets_103_19
12. Li C, Wang CC, Meng Y, Fan JY, Zhang J, Wang LJ. Ultrasonic optic nerve sheath diameter could improve the prognosis of acute ischemic stroke in the intensive care unit. Front Pharmacol. 2022 Dec 23;13:1077131. https://doi.org/10.3389/fphar.2022.1077131
13. Oshiro EM, Walter KA, Piantadosi S, Witham TF, Tamargo RJ. A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery. 1997 Jul;41(1):140–7; discussion 147-148. https://doi.org/10.1097/00006123-199707000-00029
14. Stead GA, Cresswell FV, Jjunju S, Oanh PKN, Thwaites GE, Donovan J. The role of optic nerve sheath diameter ultrasound in brain infection. eNeurologicalSci. 2021 Jun;23:100330. https://doi.org/10.1016/j.ensci.2021.100330
15. Xie Y, Fu Y, Shao Y, Qu L, Yang J, Yang C, et al. Quantitative ultrasound image assessment of the optic nerve subarachnoid space during 90-day head-down tilt bed rest. npj Microgravity. 2024 Jan 17;10(1):9. https://doi.org/10.1038/s41526-024-00347-x
16. Berhanu D, Ferreira JC, Abegão Pinto L, Aguiar De Sousa D, Lucas Neto L, Tavares Ferreira J. The role of optic nerve sheath ultrasonography in increased intracranial pressure: A systematic review and meta analysis. Journal of the Neurological Sciences. 2023 Nov;454:120853. https://doi.org/10.1016/j.jns.2023.120853
17. Florkow MC, Willemsen K, Mascarenhas VV, Oei EHG, Van Stralen M, Seevinck PR. Magnetic Resonance Imaging Versus Computed Tomography for Three‐Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review. Magnetic Resonance Imaging. 2022 Jul;56(1):11–34. https://doi.org/10.1002/jmri.28067
18. Bhide M, Juneja D, Singh O, Mohanty S. Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit. World J Crit Care Med [Internet]. 2024 Sep;13(3): 97205. https://doi.org/10.5492/wjccm.v13.i3.97205
19. Kaur A, Gautam PL, Sharma S, Singh VP, Sharma S. Bedside Ultrasonographic Assessment of Optic Nerve Sheath Diameter As a Means of Detecting Raised Intracranial Pressure in Neuro-Trauma Patients: A Cross-Sectional Study. Annals of Indian Academy of Neurology. 2021 Jan;24(1):63–8. https://doi.org/10.4103/aian.aian_51_20
20. Afonso J, Ramirez-Campillo R, Clemente FM, Büttner FC, Andrade R. The Perils of Misinterpreting and Misusing “Publication Bias” in Meta-analyses: An Education Review on Funnel Plot-Based Methods. Sports Med. 2024 Feb;54(2):257–69. https://doi.org/10.1007/s40279-023-01927-9
21. Toscano M, Spadetta G, Pulitano P, Rocco M, Di Piero V, Mecarelli O, et al. Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring. BioMed Research International. 2017;2017:1–7. https://doi.org/10.1155/2017/1621428
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Teddy Tjahyanto, Milani Suryakanto
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website). The final published PDF should be used and bibliographic details that credit the publication in this journal should be included.
