Intraindividual Optic Nerve Sheath Variation and Intracranial Pressure Changes: A Systematic Review and Meta-Analysis

To review the existing evidence on multiple timepoint assessments of optic nerve sheath diameter (ONSD) as an indicator of intraindividual variation of intracranial pressure (ICP).

A systematic search identified studies assessing intraindividual variation in ICP through multiple timepoint measurements of ONSD using ultrasonography. Meta-analysis of studies assessing intraindividual correlation coefficients between ONSD and ICP was performed using a random effects model, and we calculated the weighted correlation coefficient for the expected change in ICP associated with variations in ONSD.

A total of five studies, comprising 157 patients, were included in the review. ONSD was compared with invasive ICP measurement methods at multiple timepoints. Meta-analysis of intraindividual ONSD-ICP correlation demonstrated a correlation coefficient of 0.62 (CI: 0.50-0.71). Individual linear correlation analyses were performed in two of the studies, yielding correlation coefficients ranging from 0.79 to 1.00; however, widely variable individual slopes were found (1.51-41.43 mm/mmHg). ONSD variations ranged from 0.12 to 3.30 mm per 5 mmHg change in ICP, with a variation of 0.55 mm in adults with hypoxic brain injury and 0.77 mm in children with idiopathic intracranial hypertension.

Our findings indicate that ONSD significantly correlates with ICP, and longitudinal intraindividual assessment shows a predominantly linear correlation between both variables. A personalized ONSD-ICP correlation equation may enable accurate ICP prediction, making ONSD a useful tool for follow-up in patients with previous invasive ICP measurements, when adjusted to each patient's characteristics and pathologies.