Limited utility of optic nerve sheath diameter for monitoring intracranial pressure in patients with intracranial hemorrhage
4 affiliations
- 1Department of Neurology, University Medical Center Göttingen , ,
- 2Department of Anesthesiology, University Medical Center Göttingen , ,
- 3Department of Neurology, Saudi German Hospital , ,
- 4Department of Medical Statistics, University Medical Center Göttingen , ,
Abstract
Introduction: Monitoring intracranial pressure (ICP) is a key component in the management of patients with intracranial hemorrhage. Transorbital ultrasound (toUS)- based measurement of the optic nerve sheath diameter (ONSD) - has been proposed as a non-invasive surrogate for ICP assessment. However, substantial variability in measurement techniques and cut-off values has raised concerns regarding its reliability. This study aimed to evaluate the association between repeatedly measured ONSD and invasively measured ICP in patients with intracranial hemorrhage and to assess the ability of ONSD to reflect changes in ICP over time.
Methods: In this prospective longitudinal study ONSD was measured daily using ultrasound at 3- and 6 mm posterior to the optic disc and compared with simultaneously recorded invasive ICP measurements. A total of 55 patients with intracranial hemorrhage were included, contributing repeated measurements over a mean of 5.47 ± 2.27 days.
Results: Overall, the association between ICP and ONSD was weak. In the prespecified primary analysis, ICP was not associated with bilateral mean irONSD at 3 mm ( β = 0.004 mm per mmHg, 95% CI − 0.003 to 0.011; p = 0.169; marginal R2 = 0.3%). At 6 mm, a small but statistically significant relationship was detectable at bilateral ICP mean values for outer-reflection ONSD [ β = 0.010, 95% CI (0.002–0.019), p = 0.016; marginal r2 = 1.3%].
Conclusion: ICP explains less than 2% of the variance in ONSD in this treated cohort with predominantly controlled ICP. These findings question its reliability as a stand-alone tool for serial monitoring of dynamic ICP changes in treated neurocritical care patients and therefore should not be interpreted as a direct substitute for invasive ICP or as a stand-alone measure of short-term ICP change.
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BibTeX
@article{ahmad2026limited,
title = {{Limited utility of optic nerve sheath diameter for monitoring intracranial pressure in patients with intracranial hemorrhage}},
author = {Beschan Ahmad and Mario Maria Joachim Trappe and Lars-Olav Harnisch and Onnen Moerer and Ibrahim Allam and Fabian Kück and Ilko L. Maier},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1932373},
url = {https://europepmc.org/article/PMC/PMC13686862},
note = {CC BY},
}
RIS
TY - JOUR
TI - Limited utility of optic nerve sheath diameter for monitoring intracranial pressure in patients with intracranial hemorrhage
AU - Beschan Ahmad
AU - Mario Maria Joachim Trappe
AU - Lars-Olav Harnisch
AU - Onnen Moerer
AU - Ibrahim Allam
AU - Fabian Kück
AU - Ilko L. Maier
PY - 2026
DA - 2026/10/08
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1932373
UR - https://europepmc.org/article/PMC/PMC13686862
AB - Introduction: Monitoring intracranial pressure (ICP) is a key component in the management of patients with intracranial hemorrhage. Transorbital ultrasound (toUS)- based measurement of the optic nerve sheath diameter (ONSD) - has been proposed as a non-invasive surrogate for ICP assessment. However, substantial variability in measurement techniques and cut-off values has raised concerns regarding its reliability. This study aimed to evaluate the association between repeatedly measured ONSD and invasively measured ICP in patients with intracranial hemorrhage and to assess the ability of ONSD to reflect changes in ICP over time. Methods: In this prospective longitudinal study ONSD was measured daily using ultrasound at 3- and 6 mm posterior to the optic disc and compared with simultaneously recorded invasive ICP measurements. A total of 55 patients with intracranial hemorrhage were included, contributing repeated measurements over a mean of 5.47 ± 2.27 days. Results: Overall, the association between ICP and ONSD was weak. In the prespecified primary analysis, ICP was not associated with bilateral mean irONSD at 3 mm ( β = 0.004 mm per mmHg, 95% CI − 0.003 to 0.011; p = 0.169; marginal R2 = 0.3%). At 6 mm, a small but statistically significant relationship was detectable at bilateral ICP mean values for outer-reflection ONSD [ β = 0.010, 95% CI (0.002–0.019), p = 0.016; marginal r2 = 1.3%]. Conclusion: ICP explains less than 2% of the variance in ONSD in this treated cohort with predominantly controlled ICP. These findings question its reliability as a stand-alone tool for serial monitoring of dynamic ICP changes in treated neurocritical care patients and therefore should not be interpreted as a direct substitute for invasive ICP or as a stand-alone measure of short-term ICP change.
SN - 1664-2295
ER -