Authors
Guangzhao Li, Xiaowang Niu, Kaipeng Zhang, Shanshan Luo, Fei Yang, Xiang Li
Published in
Frontiers in neurology. Volume 17. Pages 1942849. Epub Sep 11, 2026.
Abstract
Preoperative intracranial pressure (ICP) evaluation in neurocritical patients relies on computed tomography (CT) findings, which often lack accuracy. Ultrasound-measured optic nerve sheath diameter (ONSD) offers a non-invasive alternative, but optimal measurement protocols and indices remain controversial.
We conducted a retrospective cohort study of 45 neurocritical patients undergoing emergency craniotomy with invasive ICP monitoring between January 2023 and December 2025. Preoperative ultrasound measured ONSDint, ONSDext, and 8 derivative indices. Pearson correlation analysis, receiver operating characteristic (ROC) curves, and Kappa consistency tests were used to validate associations with invasive ICP measurements.
All ONSD-derived indices correlated significantly with invasive ICP (p < 0.01). Two indices exhibited superior diagnostic performance for identifying ICP ≥ 30 mmHg: ONSDint/OND (AUC = 0.980, sensitivity = 92.6%, specificity = 94.4%, optimal cutoff = 1.56) and ONSDint-OND (AUC = 0.980, sensitivity = 96.3%, specificity = 94.4%, optimal cutoff = 2.0). Kappa analysis showed almost perfect agreement between both indices and invasive monitoring (ONSDint/OND: Kappa = 0.775, accuracy = 88.9%; ONSDint-OND: Kappa = 0.86, accuracy = 93.3%).
ONSDint/OND and ONSDint-OND are reliable non-invasive biomarkers for predicting elevated ICP in neurocritical patients, providing valuable information to guide preoperative surgical decision-making. This study validates the clinical utility of ultrasound-derived ONSD indices in optimizing ICP assessment before craniotomy.
PMID:
42798351
Bibliographic data and abstract were imported from PubMed on 26 Sep 2026.
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