Pulsatile dynamics of the optic nerve sheath and intracranial pressure: An exploratory in vivo investigation

BACKGROUND: Raised intracranial pressure (ICP) may lead to increased stiffness of the optic nerve sheath (ONS). OBJECTIVE: To develop a method for analyzing ONS dynamics from transorbital ultrasound and investigate a potential difference between patients with raised ICP vs normal ICP. METHODS: We retrospectively analyzed data from 16 patients (⩽12 years old) for whom ultrasound image sequences of the ONS had been acquired from both eyes just before invasive measurement of ICP. Eight patients had an ICP ≥20 mm Hg. The transverse motion on each side of the ONS was estimated from ultrasound, and Fourier analysis was used to extract the magnitude of the displacement corresponding to the heart rate. By calculating the normalized absolute difference between the displacements on each side of the ONS, a measure of ONS deformation was obtained. This parameter was referred to as the deformability index. According to our hypothesis, because deformability is inversely related to stiffness, we expected this parameter to be lower for ICP ≥20 mm Hg compared with ICP