Prone pozisyonun optik sinir kılıfı çapına etkisi

Öz

Amaç: Optik sinir kılıfı çapı ölçümü kafa içi basınç artışının tespitinde noninvaziv, güvenilir bir yöntemdir. Biz
çalışmamızda, ameliyathane ortamında sık kullanılan prone pozisyonun kafa içi basıncına etkisini araştırdık.
Yöntemler: Prone pozisyonda vertebra operasyonu yapılacak toplam 60 beyin cerrahi ve ortopedi hastasının
preoperatif indüksiyondan hemen önce ve postoperatif supine pozisyona alındığında ekstübasyondan önce
ultrasonografi ile her iki gözde yatay ve dikey optik sinir kılıfı çapı ölçümlerini kaydettik. Cinsiyet, süre ve sağ
göz- sol göz kıyaslamaları yapıldı.
Bulgular: Cinsiyet ve sağ göz- sol göz kıyaslamalarında fark gözlenmedi. Süre açısından kısa süren olgularda
optik sinir kılıfı çapında değişiklik yoktu. 240 dakikadan uzun süren olgularda istatistiksel olarak anlamlı olmasa
da nümerik olarak bariz artış gözlendi.
Sonuç: Prone pozisyonu kısa ve orta süreli operasyonlarda kafa içi basınç artışı yapmamaktadır. Ancak çok uzun
süreli durumlarda optik sinir kılıfı çapı artma eğilimindedir. Bu nedenle çok uzun süre prone pozisyonda tutulan
hastalarda kafa içi basınç artışı yönünden dikkatli olunmalıdır. 

Anahtar Kelimeler

• kafa içi basınç artışı
• optik sinir kılıfı çapı
• ultrasonografi
• prone pozisyon

The Impact of Prone Position on Optic Nerve Sheath Diameter

Abstract

Aim: The measurement of optic nerve sheath diameter is a reliable and non-invasive approach in determining
increased intracranial pressure (ICP). We investigated the impact of prone position, a frequently used approach
during surgery, on ICP in this present study.
Methods: Horizontal and vertical optic nerve sheath diameters for both eyes were measured by means of
ultrasonography first immediately after intubation preoperatively and then when the patient has been placed in
supine position prior to extubation postoperatively in a total of 60 patients scheduled for vertebral surgery in
prone position in neurosurgical and orthopedic theatres. They were compared in terms of sex and duration as
well as for left and right eye measurements.
Results: No significant differences were observed in terms of sex as well as right-left eye measurements in the
patients. No changes were noted in optic nerve sheath diameter in the patients with shorter operative duration.
However, there was a notable increase numerically in patients who had operation duration of over 240 minutes,
although the difference was not established to be statistically significant.
Conclusion: Prone position was not associated with increased intracranial pressure in patients who undergo short
or medium duration surgery. However, optic nerve sheath diameter is likely to increase in patients who undergo
longer surgery. Therefore, care has to be taken in terms of elevated ICP in patients who remain in prone position
for extended periods.

Keywords

• Intracranial pressure increase
• optic nerve sheath diameter
• ultrasonography
• prone position

Kaynakça

1. References 1. Monro A. Observation on the features and functions of the nervous system, illustrated with tables. London medical journal IV: 113-135, 1783
2. 2. Keegan MT, Wijdicks EFM. Increased Intracranial Pressure, Neurological Disorders Course and Treatment. in Brandt CT, Caplan LR, Dichgans J, Diener HC, Kennard C (ed), Intensive Care in Neurology. Academic Press, 2003: 749–763
3. 3. Pinto VL, Tadi P, Adeyinka A. Increased Intracranial Pressure. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed September 27, 2021
4. 4. You AH, Song Y, Kim DH, Suh J, Baek JW, Han DW. Effects of positive end-expiratory pressure on intraocular pressure and optic nerve sheath diameter in robot-assisted laparoscopic radical prostatectomy: A randomized, clinical trial. Medicine (Baltimore). e15051, 2019
5. 5. Freeman WD: Raised intracranial pressure. In Blackwell W (ed), Evidence-Based Neurology: Management of Neurological Disorders: Second Edition, 2015: 87-92
6. 6. Dadı B, Uyar E, Asadov R, Girgin Fİ, Ekinci G, Öztürk NY. Comparison of Ultrasound Guided Optic Nerve Sheath Diameter Measurements with Other Cranial Imaging Methods (Cranial Computed Tomography and Magnetic Resonance Imaging) in Pediatric Intensive Care Patients. Turkish J. Pediatr. Emerg. Intensive Care Med.6: 1–6, 2019
7. 7. Chin JH, Seo H, Lee EH, Lee J, Hong JH, Hwang JH, et al. Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position. BMC Anesthesiol.15: 1–6, 2015
8. 8. Dölen D, Sabancı PA. Brain Edema and Intracranial Pressure Changes in Head Trauma (in Turkish). Türk Nöroşir Derg 30 (2): 187–193, 2020

9. 9. Kristiansson H, Nissborg E, Bartek J, Andresen M, Reinstrup P, Romner B. Measuring elevated intracranial pressure through noninvasive methods: A review of the literature. J. Neurosurg. Anesthesiol.25: 372–385, 2013
10. 10. Major R, Girling S. Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg. Med. J.28: 679–681, 2011
11. 11. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients. Ann. Emerg. Med.49: 508–514, 2007
12. 12. İyilikçi L, Ökesli S, Işık B, Alper I, Erdost HA, Noyan A, et al. Günübi̇rli̇k Anestezi̇, Anestezi Uygulama Kılavuzları (in Turkish). [Türk Anesteziyoloji ve Reanimasyon Derneği -TARD- web site]. December, 2015. Available at: https://www.tard.org.tr/assets/kilavuz/5.pdf. Accessed September 27, 2021