Non-invasive fundoscopy as a tool to estimate intracranial pressure: a large animal model

IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY
Niclas Lynge Eriksen, Frantz Rom Poulsen, Mikkel Schou Andersen, Mathias Just Nortvig
{"title":"Non-invasive fundoscopy as a tool to estimate intracranial pressure: a large animal model","authors":"Niclas Lynge Eriksen,&nbsp;Frantz Rom Poulsen,&nbsp;Mikkel Schou Andersen,&nbsp;Mathias Just Nortvig","doi":"10.1007/s00701-025-06437-3","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Intracranial pressure (ICP) monitoring is in most studies considered essential in avoiding secondary brain injury in patients with intracranial pathologies. Invasive monitoring of ICP is accurate but is unavailable in many clinical and prehospital settings. Non-invasive modalities have historically been difficult to implement clinically. The retinal arteriovenous ratio (A/V ratio) has shown promise through its relationship with ICP.</p><p>This study aimed to further elucidate the relationship between ICP, A/V ratio and the intraocular pressure (IOP) measured with non-invasive fundoscopy in a porcine model.</p><h3>Methods</h3><p>We achieved controlled values of ICP ranging from normal (5–15 mmHg) to elevated (&gt; 20 mmHg) within the same animal subject. Six pigs were included. ICP and IOP was measured using an intraparenchymal pressure monitor and a tonometer, respectively. Fundoscopy was performed at baseline and at predefined ICP values.</p><h3>Results</h3><p>Mixed-effects linear regression revealed a significant inverse correlation between A/V ratio and ICP ≥ 20 mmHg (slope coefficient − 0.0026734 [95%-CI: −0.0039347 – (−0.0014121)], <i>p</i> &lt; 0.001). For ICP &lt; 20 mmHg there was no change in A/V ratio (<i>p</i> = 0.987). Similar results were seen for ICP &gt; IOP with a mean IOP of 10 mmHg. A Wald test showed no significant difference between ICP &gt; IOP and ICP ≥ 20 mmHg. ROC curve analysis revealed an AUC of 0.64 for ICP ≥ 20 mmHg and 0.71 for ICP &gt; IOP.</p><h3>Conclusion</h3><p>The results support the hypothesis that an increase in ICP was associated with a decrease in A/V ratio. Although a slightly better fit, the model of ICP &gt; IOP was deemed less clinically relevant than ICP ≥ 20 mmHg because of the subjects’ IOP.</p><p>Further research integrating multifactorial models and machine learning is needed to enhance the diagnostic accuracy of A/V ratio via fundoscopy, enabling it to serve as a cost-effective screening tool.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762002/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00701-025-06437-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose

Intracranial pressure (ICP) monitoring is in most studies considered essential in avoiding secondary brain injury in patients with intracranial pathologies. Invasive monitoring of ICP is accurate but is unavailable in many clinical and prehospital settings. Non-invasive modalities have historically been difficult to implement clinically. The retinal arteriovenous ratio (A/V ratio) has shown promise through its relationship with ICP.

This study aimed to further elucidate the relationship between ICP, A/V ratio and the intraocular pressure (IOP) measured with non-invasive fundoscopy in a porcine model.

Methods

We achieved controlled values of ICP ranging from normal (5–15 mmHg) to elevated (> 20 mmHg) within the same animal subject. Six pigs were included. ICP and IOP was measured using an intraparenchymal pressure monitor and a tonometer, respectively. Fundoscopy was performed at baseline and at predefined ICP values.

Results

Mixed-effects linear regression revealed a significant inverse correlation between A/V ratio and ICP ≥ 20 mmHg (slope coefficient − 0.0026734 [95%-CI: −0.0039347 – (−0.0014121)], p < 0.001). For ICP < 20 mmHg there was no change in A/V ratio (p = 0.987). Similar results were seen for ICP > IOP with a mean IOP of 10 mmHg. A Wald test showed no significant difference between ICP > IOP and ICP ≥ 20 mmHg. ROC curve analysis revealed an AUC of 0.64 for ICP ≥ 20 mmHg and 0.71 for ICP > IOP.

Conclusion

The results support the hypothesis that an increase in ICP was associated with a decrease in A/V ratio. Although a slightly better fit, the model of ICP > IOP was deemed less clinically relevant than ICP ≥ 20 mmHg because of the subjects’ IOP.

Further research integrating multifactorial models and machine learning is needed to enhance the diagnostic accuracy of A/V ratio via fundoscopy, enabling it to serve as a cost-effective screening tool.

无创眼底镜作为评估颅内压的工具:一个大型动物模型。
目的:在大多数研究中,颅内压(ICP)监测被认为是避免颅内病变患者继发性脑损伤的必要条件。侵入性颅内压监测是准确的,但在许多临床和院前设置是不可用的。非侵入性模式历来难以在临床上实施。视网膜动静脉比(A/V比)通过其与ICP的关系显示出希望。本研究旨在进一步阐明猪无创眼底镜下颅内压(ICP)、A/V比与眼内压(IOP)的关系。方法:我们在同一动物受试者中获得了从正常(5- 15mmhg)到升高(> - 20mmhg)的ICP控制值。包括6头猪。颅内压和眼压分别用实质内压监测仪和眼压计测量。在基线和预先定义的ICP值下进行眼底镜检查。结果:混合效应线性回归显示,a /V比与ICP≥20 mmHg(斜率系数- 0.0026734 [95% ci: -0.0039347 -(-0.0014121)]、p IOP(平均IOP为10 mmHg)呈显著负相关。Wald检验显示,颅内压> IOP与颅内压≥20mmhg无显著差异。ROC曲线分析显示,ICP≥20 mmHg时AUC为0.64,ICP≥20 mmHg时AUC为0.71。结论:结果支持ICP升高与a /V比值降低相关的假设。虽然稍微适合,但由于受试者的IOP, ICP > IOP模型的临床相关性不如ICP≥20 mmHg。需要进一步研究将多因素模型和机器学习相结合,以提高通过眼底镜诊断A/V比的准确性,使其成为一种具有成本效益的筛查工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Acta Neurochirurgica
Acta Neurochirurgica 医学-临床神经学
CiteScore
4.40
自引率
4.20%
发文量
342
审稿时长
1 months
期刊介绍: The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信