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Neurosurgery. 2016 Jul;79(1):100-7. doi: 10.1227/NEU.0000000000001200.

Pulsatile Dynamics of the Optic Nerve Sheath and Intracranial Pressure: An Exploratory In Vivo Investigation.

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‡Division of Neurosurgery, University of Cape Town, Cape Town, South Africa; §Red Cross War Memorial Children's Hospital, Cape Town, South Africa; ¶Department of Medical Technology, SINTEF, Trondheim, Norway.



Raised intracranial pressure (ICP) may lead to increased stiffness of the optic nerve sheath (ONS).


To develop a method for analyzing ONS dynamics from transorbital ultrasound and investigate a potential difference between patients with raised ICP vs normal ICP.


We retrospectively analyzed data from 16 patients (≤12 years old) for whom ultrasound image sequences of the ONS had been acquired from both eyes just before invasive measurement of ICP. Eight patients had an ICP ≥20 mm Hg. The transverse motion on each side of the ONS was estimated from ultrasound, and Fourier analysis was used to extract the magnitude of the displacement corresponding to the heart rate. By calculating the normalized absolute difference between the displacements on each side of the ONS, a measure of ONS deformation was obtained. This parameter was referred to as the deformability index. According to our hypothesis, because deformability is inversely related to stiffness, we expected this parameter to be lower for ICP ≥20 mm Hg compared with ICP <20 mm Hg. The one-sided Mann-Whitney U test was used for statistical comparison.


The deformability index was significantly lower in the group with ICP ≥20 mm Hg (median value 0.11 vs 0.24; P = .002).


We present a method for assessment of ONS pulsatile dynamics using transorbital ultrasound imaging. A significant difference was noted between the patient groups, indicating that deformability of the ONS may be relevant as a noninvasive marker of raised ICP. The clinical implications are promising and should be investigated in future clinical studies.


AUC, area under curveICP, intracranial pressureONS, optic nerve sheathONSD, optic nerve sheath diameterROC, receiver operating characteristic.

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