The correlation of optic nerve sheath diameter with clinical outcomes in patients undergoing decompressive craniectomy for cerebral infarction.

Abstract

Background: This study aims to investigate the relationship between optic nerve sheath diameter (ONSD) measurements and clinical outcomes in patients undergoing decompressive craniectomy (DC) due to cerebral infarction. The study evaluated the effect of ONSD on intracranial pressure (ICP) and neurological recovery after DC and determined the prognostic value of this measurement.

Methods: This study was conducted on 54 patients who underwent DC for cerebral infarction between 2018 and 2024 at a tertiary university hospital, Atatürk university faculty of medicine. Demographic data (age, gender), clinical data (preoperative and postoperative Glasgow Coma Scale [GCS] scores, Glasgow Outcome Scale [GOS] scores), and ONSD measurements were obtained from patient records. ONSD measurements were taken at preoperative 1 h, postoperative 1 h, postoperative 24 h, and postoperative 72 h. Measurements were performed with an ultrasound probe on both eyes while patients were in a supine position with their eyes closed. Patients were divided into two groups based on their GCS scores: Group 1 (GCS > 8) and Group 2 (GCS ≤ 8). Statistical analyses of the data were performed using Student's t-test and Mann-Whitney U-test, with P < 0.05 considered statistically significant.

Results: Group 1 consisted of 26 patients (mean age 67.2 ± 6.4 years), and Group 2 consisted of 28 patients (mean age 72.4 ± 5.8 years) (P = 0.019). Preoperative ONSD was significantly wider in Group 2 (6.3 ± 0.5 mm) compared to Group 1 (5.2 ± 0.4 mm) (P ≈ 0). Postoperative 1-h ONSD values were also significantly wider in Group 2 (6.0 ± 0.6 mm) compared to Group 1 (4.8 ± 0.5 mm) (P ≈ 0). At 24 and 72 h, ONSD values in Group 2 remained significantly wider compared to Group 1. GOS scores were lower in Group 2 (2.1 ± 0.9) compared to Group 1 (3.2 ± 0.8) (P ≈ 0). There was a strong negative correlation between ONSD measurements and GOS scores.

Conclusion: ONSD is an important non-invasive indicator in the assessment of ICP and clinical outcomes. High ONSD values are associated with poor clinical outcomes, and a reduction in postoperative ONSD reflects the success of surgical intervention. ONSD measurements can be used as a prognostic tool in clinical practice and play a crucial role in the management and monitoring of patients with high ICP. It is recommended that these findings be validated in larger patient groups and different clinical scenarios.