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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(07): 671-675
DOI: 10.1055/s-0042-1754345
Original Article

Role of the optic nerve sheath diameter in the assessment of the effectiveness of decompressive surgery after malignant middle cerebral artery infarction

Papel do diâmetro da bainha do nervo óptico na avaliação da eficácia da cirurgia descompressiva após infarto maligno da artéria cerebral média
Ozgur Senol 
1   Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurosurgery, Bolu, Turkey.
,
Zeliha Cosgun 
2   Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Radiology, Bolu, Turkey.
,
Emine Dagistan 
2   Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Radiology, Bolu, Turkey.
,
Bekir Enes Demiryurek 
3   Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurology, Bolu, Turkey.
,
Seckin Emre Cancan 
1   Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurosurgery, Bolu, Turkey.
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Abstract

Background After a case of stroke, intracranial pressure (ICP) must be measured and monitored, and the gold standard method for that is through an invasive technique using an intraventricular or intraparenchymal device. However, The ICP can also be assessed through a non-invasive method, comprised of the measurement of the optic nerve sheath diameter (ONSD) through ultrasound (US).

Objective To evaluate the ICP of patients who underwent wide decompressive craniectomy after middle cerebral artery (MCA) infarction via preoperative and postoperative ONSD measurements.

Methods A total of 17 patients, aged between 34 and 70 years, diagnosed with malignant MCA infarction with radiological edema and mid-line shift, who underwent decompressive surgery, were eligible. From the records, we collected data on age, sex, preoperative and postoperative Glasgow Coma Scale (GCS) scores, National Institutes of Health Stroke Scale (NIHSS) score, the degree of disability in the preoperative period and three months postoperatively through the scores on the Modified Rankin Scale (MRS), and the preoperative and postoperative midline shift measured by computed tomography (CT) scans of the brain.

Results Preoperatively, the mean GCS score was of 8 (range: 7.7–9.2), whereas it was found to be of 12 (range 10–14) on the first postoperative day (p = 0.001). The mean preoperative NIHSS score was of 21.36 ± 2.70 and, on the first postoperative day, it was of 5.30 ± 0.75 (p < 0.001). As for the midline shift, the mean preoperative value was of 1.33 ± 0.75 cm, and, on the first postoperative day, 0.36 ± 0.40 cm (p < 0.001). And, regarding the ONSD, the mean preoperative measurement was of 5.5 ± 0.1 mm, and, on the first postoperative day, it was of 5 ± 0.9 mm (p < 0.001).

Conclusion The ocular US measurement of the ONSD for the preoperative and postoperative monitoring of the ICP seems to be a practical and useful method.

Resumo

Antecedentes Após um acidente vascular cerebral (AVC), a pressão intracraniana (PIC) deve ser medida e monitorada, e o método padrão-ouro para isso é um procedimento invasivo por meio de um dispositivo intraventricular ou intraparenquimal. No entanto, a PIC também pode ser avaliada por um método não invasivo, composto da medida do diâmetro da bainha do nervo óptico (DBNO) por ultrassom (US).

Objetivo Avaliar a PIC de pacientes submetidos a craniectomia descompressiva ampla após infarto da artéria cerebral média (ACM) por meio das medidas do DBNO nos períodos pré e pós-operatório.

Métodos Um total de 17 pacientes, com idades entre 34 e 70 anos, diagnosticados com infarto maligno da ACM com edema radiológico e deslocamento da linha média, e que foram submetidos a cirurgia descompressiva, eram elegíveis. A partir dos prontuários, coletamos informações relativas à idade, gênero, pontuações pré e pós-operatória na Escala de Coma de Glasgow (ECG), pontuação na escala de AVC dos National Institutes of Health (NIH), o grau de incapacidade no pré-operatório e após três meses da operação pelas pontuações na Escala de Rankin Modificada (ERM), e o desvio da linha média no pré e pós-operatório medido por tomografia computadorizada (TC) cerebral.

Resultados No pré-operatório, a pontuação média na ECG foi de 8 (variação: 7,7–9,2), e, no primeiro dia do pós-operatório, 12 variação 10–14) (p = 0,001). A pontuação média na escala dos NIH foi de 21,36 ± 2,70 no pré-operatório, e de 5,30 ± 0,75 no primeiro dia de pós-operatório (p < 0,00 1). Quanto ao desvio da linha média, no pré-operatório ele teve uma média de 1,33 ± 0,75 cm, e de 0,36 ± 0,40 cm no primeiro dia de pós-operatório (p < 0,001). E o DBNO apresentou uma média pré-operatória de 5,5 ± 0,1 mm, e de 5 ± 0,9 mm no primeiro dia de pós-operatório (p < 0,001).

Conclusão A mensuração ocular do DBNO por US para o monitoramento da PIC no pré e no pós-operatório parece ser um método prático e útil.

Keywords

Middle Cerebral Artery - Infarction - Decompressive Craniectomy - Optic Nerve Neoplasms

Palavras-chave

Artéria Cerebral Média - Infarto - Craniectomia Descompressiva - Neoplasias do Nervo óptico

Authors' Contributions

BED, OS, YD: contributed substantially to the conception or design of the study; ED, ZC, SEC: contributed to the collection, analysis, or interpretation of data; OS, YD: contributed to the writing or critical review of the manuscript; BED, ZC: contributed to the approval of the final version to be published.




Publication History

Received: 10 November 2021

Accepted: 26 September 2020

Article published online:
29 September 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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