The Authors Reply: Correlation Between Ultrasonographic Optic Nerve Sheath Diameter and Intracranial Pressure in Patient
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RESPONSE TO LETTER TO THE EDITOR
The Authors Reply: Correlation Between Ultrasonographic Optic Nerve Sheath Diameter and Intracranial Pressure in Patients with Aneurysmal Subarachnoid Hemorrhage Alessio Caccioppola1,2, Tommaso Zoerle1,2* and Nino Stocchetti1,2 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Dear Editor, We thank Dr. Varun Suresh and colleagues for their comments on our recent paper [1] suggesting different pathophysiological mechanisms that could explain the poor relationship between intracranial pressure (ICP) values and the optic nerve sheath diameter (ONSD) in subarachnoid patients (SAH). We think that this negative result is related to the severity of intracranial hypertension at the moment of aneurysm bleeding, causing acute and partially irreversible sheet distension [2]. Obviously, we cannot exclude that other factors such as inflammation and cerebrospinal fluid (CSF) compartmentalization secondary to the intracranial bleeding could be involved. Further experimental studies exploring optic nerve structures damage and CSF dynamics after SAH could be helpful to clarify these points. Moreover, the authors propose stratified analysis based on different characteristics (bleeding severity, aneurysm location and treatment), but the number of patients included in the study was too small. Studies including a larger and/or more homogenous population are necessary for this purpose. Lastly, we would like to clarify the method to measure the ONSD. The sonographic aspect of the optic nerve is *Correspondence: [email protected] 1 Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy Full list of author information is available at the end of the article This comment refers to the articles available at https://doi.org/10.1007/ s12028-020-00970-y, https://doi.org/10.1007/s12028-020-01087-y.
from center to peripheral: hypoechogenic nerve fibers closely surrounded by the echogenic pia mater; the subarachnoid space appears anechogenic or hypoechogenic and is surrounded by hyperechogenic dura mater and periorbital fat [3, 4]. ONSD was considered as the distance inside dura mater. Author details 1 Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy. 2 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. Conflict of interest The authors declare that they have no conflict of interest.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Received: 14 August 2020 Accepted: 20 August 2020
References 1. Zoerle T, Caccioppola A, D’Angelo E, Carbonara M, Conte G, Avignone S, Zanier ER, Birg T, Ortolano F, Triulzi F, Stocchetti N. Optic nerve sheath diameter is not related to intracranial pressure in subarachnoid hemorrhage patients. Neurocr
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